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Oversized donor heart transplantation-clinical experience with an underestimated problem
Srikanth Kasturi1, Thiruthani Kumaran1,2, Varun Shetty1
1Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, India.
Insights
Oversized heart transplants, while presenting unique challenges, show comparable outcomes to matched transplants. Efficient management is key to success in these cases.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Outcomes
Background:
- Heart transplantation is the primary treatment for end-stage heart failure.
- Donor-recipient size matching is crucial, with undersized transplants well-documented.
- Limited data exists on oversized heart transplants, despite potential benefits.
Purpose of the Study:
- To analyze the outcomes and challenges of oversized heart transplantation.
- To contribute knowledge regarding the management of oversized cardiac allografts.
- To evaluate the safety and efficacy of using larger donor hearts in recipients.
Main Methods:
- Retrospective analysis of isolated heart transplant recipients from March 2008 to March 2020.
- Defined oversized transplants using specific donor-recipient size/weight ratios.
- Collected and analyzed in-hospital outcomes and post-transplant survival data.
Main Results:
- 11 out of 43 patients (25.6%) received oversized hearts; none received undersized organs.
- In-hospital mortality was 18.2% for oversized vs. 9.4% for matched transplants (p=0.432).
- Post-operative characteristics and 1-year survival were similar between groups; 45.4% of oversized transplants had specific issues.
Conclusions:
- Liberalized donor criteria increase the use of oversized heart transplants.
- Oversized cardiac allografts present unique challenges requiring effective management.
- Acceptable outcomes can be achieved with proper management of oversized heart transplants.
Purpose:
Heart transplantation is the definitive treatment for end-stage heart failure. With respect to donor-recipient size matching, the problems with undersized heart transplantation have been widely discussed, but there is a paucity of information on oversized transplants due to the presumed advantage of large hearts. We intend to share our center's experience with oversized heart transplantation and its associated problems which would help to expand the knowledge on oversized cardiac allografts.
Methods:
Patients who underwent isolated heart transplantation at our hospital between March 1, 2008, and March 1, 2020, were included. For adults, a donor-recipient predicted heart mass percentage difference exceeding 30% and for children, a donor-recipient weight ratio < 0.8 and > 2.0 was considered a mismatch. We collected data from the in-patient medical records and analyzed the in-hospital outcomes and survival post-transplant among various other parameters.
Results:
Out of the 43 patients included in this study, 32 (74.4%) patients received a matched heart and 11 (25.6%) patients received oversized hearts. None of the patients received an undersized heart. The in-hospital mortality rate of oversized transplants was 18.2% whereas that of matched transplants was 9.4% (p = 0.432). The post-operative characteristics and 1-year survival were comparable between the groups. We encountered problems specific to oversizing in 5 of the 11 patients (45.4%) which are discussed.
Conclusion:
With the liberalization of donor criteria to overcome organ shortage, oversized heart transplantation poses certain unique challenges, which when efficiently managed offers acceptable outcomes.
