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Sizing heart transplant donors in adults with congenital heart disease
Daniel E Clark1, Ryan D Byrne2, Jeremy A Mazurek3
1Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
Insights
Donor oversizing in heart transplantation (HT) for adults with congenital heart disease (CHD) does not impact survival rates. This study found no significant difference in mortality based on donor size matching in the adult CHD population.
Area of Science:
- Cardiology
- Transplantation Medicine
- Congenital Heart Disease
Background:
- Optimal donor sizing for heart transplantation (HT) in adults with congenital heart disease (CHD) is not well-established.
- Adults with CHD often have complex physiology, including pulmonary hypertension and prior surgical interventions, complicating donor selection.
Purpose of the Study:
- To investigate the impact of donor size matching on heart transplantation outcomes in adult patients with congenital heart disease.
- To determine if donor oversizing affects survival in this specific patient population.
Main Methods:
- Retrospective cohort analysis of 827 adult patients with CHD undergoing HT in the United States from 2000-2015.
- Data sourced from the United Network for Organ Sharing (UNOS) database.
- Analysis of all-cause mortality and survival based on donor size matching (predicted heart mass ratio).
Main Results:
- At a median follow-up of 1462 days, 66.3% of subjects survived.
- All-cause mortality did not significantly differ based on donor size matching (HR, 1.03; P=.74).
- Pulmonary hypertension was not significantly associated with survival in this cohort (χ²=2.01, P=.73).
Conclusions:
- Donor oversizing, within the range used in current practice, does not adversely affect survival after HT in adults with CHD.
- Current practices of donor oversizing in adult CHD heart transplant recipients are not associated with improved mortality outcomes.
Objective:
Optimal donor sizing for heart transplantation (HT) in adults with congenital heart disease (CHD) remains unclear, given the propensity for pulmonary hypertension related to shunting, staged repairs, and periods of pulmonary overcirculation. We studied HT outcomes related to donor size matching in the adult CHD population.
Methods:
We conducted a retrospective cohort analysis of patients with CHD undergoing HT in the United States from January 1, 2000, to December 31, 2015. Patients were selected from the United Network for Organ Sharing database; 827 patients met inclusion criteria and were analyzed.
Results:
At a median follow-up of 1462 days, 548 (66.3%) subjects were alive and 279 (33.7%) were deceased. All-cause mortality did not differ based on donor sizing (by predicted heart mass ratio: hazard ratio, 1.03; confidence interval, 0.86-1.23; P = .74). Pulmonary hypertension was not significantly associated with survival (by predicted heart mass ratio, χ2 = 2.01, P = .73).
Conclusions:
Our data demonstrate that donor oversizing, to the extent used in current practice, does not affect survival after HT in adults with CHD. Our findings from the United Network for Organ Sharing database demonstrate that donor oversizing in these patients is not associated with improved mortality.
