Related Experiment Videos
Posttransplantation hemodynamics and exercise function are not affected by body-size matching of donor and recipient
Insights
Using undersized donor hearts for transplantation does not negatively impact patient exercise capacity or 1-year hemodynamics. This finding supports expanded donor criteria for heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Heart transplantation is limited by donor organ availability.
- Expanded donor criteria, including body-size mismatch, are increasingly used.
- The impact of undersized donor hearts on post-transplant function requires further examination.
Purpose of the Study:
- To assess exercise capacity and 1-year hemodynamics in heart transplant recipients receiving hearts from donors of varying sizes relative to the recipient.
- To determine if donor-recipient weight ratio or body surface area ratio affects post-transplant outcomes.
Main Methods:
- Retrospective analysis of 72 adult orthotopic heart transplant recipients.
- Patients grouped by donor-recipient weight ratio (low, mid, high) and body surface area ratio (<1.0 vs. >=1.0).
- Assessment of total exercise time, relative oxygen consumption, and 1-year post-transplantation hemodynamics.
Main Results:
- No significant differences in exercise capacity (total exercise time, relative oxygen consumption) were found across donor-recipient weight ratio groups.
- One-year post-transplantation hemodynamics were similar regardless of donor-recipient weight ratio or body surface area ratio.
- Neither donor-recipient weight ratio nor body surface area ratio correlated with post-transplantation hemodynamic measurements.
Conclusions:
- Donor-recipient size matching (weight or body surface area) is not a significant determinant of exercise capacity or 1-year hemodynamic function after heart transplantation.
- These findings support the use of expanded donor criteria, including undersized donor hearts, to increase organ availability without compromising short-term functional outcomes.
Abstract:
Because the number of heart transplantations performed is limited by the number of available donor hearts, many centers have expanded the acceptable criteria for donor hearts in an attempt to provide a sufficient number of donors for the number of patients awaiting heart transplantation. Traditionally, body-size matching has been an important criteria for matching donors with potential heart transplant recipients. Although initially thought to be detrimental, studies have shown no difference in survival of patients who receive hearts from smaller donors, but heart performance in this subset of patients who receive undersized hearts has not been extensively examined. We assessed exercise capacity and 1-year posttransplantation hemodynamics in 72 consecutive adult orthotopic heart transplant recipients, grouped according to donor-recipient weight ratio and the ratio of donor to recipient body surface area. Total exercise time and relative oxygen consumption were not significantly different among three groups of patients grouped according to donor-recipient body weight ratio as follows: low, 0.60 to 0.79; mid, 0.80 to 1.0; high, more than 1.0. No difference was noted among the three donor-recipient weight ratio groups with respect to 1-year posttransplantation hemodynamics. Similarly, 1-year posttransplantation hemodynamics were not different between patients with a body surface area ratio of less than 1.0 versus those with a body surface area ratio of 1.0 or more. Differences in pretransplantation hemodynamics or graft preservation did not affect our results. Neither donor-recipient weight ratio nor body surface area ratio correlated with any posttransplantation hemodynamic measurement.(ABSTRACT TRUNCATED AT 250 WORDS)