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Domino heart transplant following heart-lung transplantation: a systematic review and meta-analysis
Elizabeth J Maynes1, Thomas J O'Malley1, Melissa A Austin1
1Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Insights
The domino procedure, a heart transplant technique, offers a viable option for select patients. This systematic review found acceptable outcomes, suggesting its safety and effectiveness in specific cases.
Area of Science:
- Cardiology
- Transplant Surgery
- Pulmonary Hypertension
Background:
- The domino-donor operation involves using a heart from a heart-lung transplant recipient for a separate heart transplant recipient.
- This procedure is a complex surgical option requiring careful patient selection.
Purpose of the Study:
- To systematically review the indications and outcomes of the domino procedure.
- To evaluate the safety and efficacy of this heart transplant variation.
Main Methods:
- A comprehensive electronic search of English literature for prospective and retrospective studies on the domino procedure.
- Inclusion of eight studies encompassing 183 heart-lung transplant recipients and 263 heart transplant recipients.
Main Results:
- Common indications for heart-lung transplant recipients included cystic fibrosis (58%) and primary pulmonary hypertension (17%).
- Heart transplant indications were primarily ischemic heart disease (40%) and non-ischemic disease (39%).
- Overall mortality was 28% for heart-lung transplant recipients and 35% for heart transplant recipients, with varying follow-up periods.
Conclusions:
- The domino procedure is a feasible option for carefully selected patients.
- The technique demonstrates acceptable outcomes, supporting its potential use in specific clinical scenarios.
Background:
The domino-donor operation occurs when a "conditioned" heart from the heart-lung transplant (HLT) recipient is transplanted into a separate heart transplant (HT) recipient. The purpose of this systematic review was to investigate the indications and outcomes associated with the domino procedure.
Methods:
An electronic search was performed to identify all prospective and retrospective studies on the domino procedure in the English literature. Eight studies reported 183 HLT recipients and 263 HT recipients who were included in the final analysis.
Results:
HLT indications included cystic fibrosis in 58% (95% CI: 27-84%) of recipients, primary pulmonary hypertension (PPH) in 17% (95% CI: 12-24%), bronchiectasis in 5% (95% CI: 3-10%), emphysema in 5% (95% CI: 0-45%), and Eisenmenger's syndrome in 4% (95% CI: 2-8%). HT indications included ischemic heart disease in 40% (95% CI: 33-47%), non-ischemic disease in 39% (95% CI: 25-56%), and re-transplantation in 10% (95% CI: 1-59%). The pooled mean pulmonary vascular resistance (PVR) in HT recipients was 3.05 Woods units (95% CI: 0.14-5.95). The overall mortality in the HLT group was 28% (95% CI: 18-41%) at an average follow-up of 15.68 months (95% CI: 0.82-30.54), and 35% (95% CI: 17-58%) in the HT group at an average follow-up of 37.26 months (95% CI: 6.68-67.84). Freedom from rejection in HT was 94% (95% CI: 75-99%) at 1 month, 77% (95% CI: 30-96%) at 6 months, and 41% (95% CI: 33-50%) at 1 year.
Conclusions:
The domino procedure appears to be a viable option in properly selected patients that can be performed safely with acceptable outcomes.
