The Journal of Thoracic and Cardiovascular Surgery
Adult: Heart TransplantationTotal ventricular mass oversizing +50% or greater was a predictor of worse 1-year survival after heart transplantation
Graphical abstract
Section snippets
Data Source
We used the United Network for Organ Sharing (UNOS) Database as a source of de-identified donor and recipient HTx data. This database consists of prospectively collected donor and recipient demographic and transplant data for all organ transplants performed in the United States. Because the UNOS database is publicly available and deidentified, this study was deemed exempt from Institutional Review Board review.
Inclusion and Exclusion Criteria
We included adult HTx recipients who received transplantation from January 1997 to
Donor-Recipient Matching
Figure 1 shows the distribution of TVM mismatch in all donor-recipient pairs. Median TVM mismatch was 2.8% (interquartile range, −5.8% to +14.8%).
Figure E2 shows the distribution of donor-recipient sex matching in the entire cohort. A total of 21.0% of transplants had sex mismatch. Female donor to male recipient pairings comprised 8.8% (N = 3016) of transplants. Figure E3, A-C, demonstrates the breakdown of gender mismatch in the different TVM mismatch groups. Groups with TVM oversizing had a
Discussion
This retrospective analysis of the UNOS database explored the impact of TVM oversizing on outcomes of HTxs performed over a 20-year period between 1997 and 2017. Our findings suggest that TVM mismatch greater than +50% is associated with a higher risk of 1-year mortality, but donor hearts with TVM mismatch +30% to +50% are not associated with a higher risk of 1-year mortality. The post-HTx mortality seen with TVM mismatch greater than +50% is observed early within the post-HTx period. However,
Conclusions
Assessing TVM before HTx may be useful in predicting outcomes. We analyzed donor TVM and its effect on HTx results using the UNOS registry. TVM mismatch greater than +50% is associated with worse 1-year survival, although comprising a small portion of transplants. TVM mismatch between +30% and +50% did not show worse survival. These donors should be considered for more liberal use with appropriate risk and benefit considerations under clinical experience (Video 1 and Figure 4).
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Cited by (1)
Commentary: Total ventricular mass: Too much of a good thing?
2023, Journal of Thoracic and Cardiovascular Surgery
Because the UNOS database is publicly available and deidentified, this study was deemed exempt from Institutional Review Board review.
- 1
M.K. and A.C.C. are co-first authors.