Contemporary Outcomes of Heart Transplantation with Moderate to Severe Donor Left Ventricular Hypertrophy

Donor hearts with left ventricular hypertrophy (LVH) are often declined because of inconsistent outcomes and program-dependent hesitation. This study evaluated contemporary use and outcomes of LVH donor hearts in adult heart transplantation (HT).

Adults (aged ≥18 years) undergoing isolated primary HT between October 2018 and December 2024 were analyzed from the United Network for Organ Sharing registry. Donors were stratified by interventricular septal or posterior left ventricular wall thickness: normal (<1.1 cm), mild (1.1-1.3 cm), and moderate-severe (>1.4 cm). Temporal trends in LVH donor use were evaluated by linear regression; survival was assessed with Kaplan-Meier and Cox proportional hazards models.

Among 8058 recipients, 583 (7.2%) received moderate-severe LVH donor hearts. Use of these donors declined over time (β, -1.62%/yr; P = .012). Survival was similar across LVH groups at 30 days (P = .531), 1 year (P = .336), and 3 years (P = .343). In multivariate analysis, neither mild LVH (hazard ratio [HR], 0.95; P = .447) nor moderate-severe LVH (HR, 1.02; P = .772) predicted higher 3-year mortality or acute rejection (P = .678). Independent predictors of 3-year mortality included donor age >55 years (HR, 1.01; P < .0001), female donor (HR, 1.11; P = .022), ischemic time >4 hours (HR, 1.03; P = .001), use of ex vivo machine perfusion (HR, 1.24; P = .034), extracorporeal membrane oxygenation bridge to transplantation (HR, 1.63; P < .0001), and donation after circulatory death status (HR, 1.29; P = .043). Across these high-risk subgroups, 3-year survival remained comparable between recipients of LVH and non-LVH donor hearts (all P < .190).

Despite declining use, moderate-severe LVH donor hearts provide comparable midterm survival and show no adverse interactions across high-risk features, findings supporting selective expansion of donor acceptance criteria to include these hearts.