Increasing heart transplant donor pool by liberalization of size matching
Section snippets
Study design
We performed a retrospective chart analysis of consecutive patients undergoing HT at the University of Chicago between April 2007 and September 2017. The University of Chicago Institutional Review Board approved this retrospective chart review. Heart allocation at the University of Chicago incorporates LVEDD matching and does not exclude donor hearts solely based on weight matching criteria. Pre-transplant donor information, including height, weight, and echocardiographic data, were retrieved
Patient characteristics
Two hundred eighty-eight consecutive patients comprised the study cohort. The mean age was 53 ± 11 years, and 76% were males (Table 1). Out of the 288 patients, 58 were bridged to transplantation with LVAD.
Based on DRWR, 46 (16%) patients were in the undersized group (0.61 ± 0.05), 210 (73%) patients were in the size-matched group (0.94 ± 0.16), and 32 (11.1%) patients were in the oversized group (1.65 ± 0.38).
There were no significant differences in demographics, gender mismatch,
Discussion
In the current study, we evaluated the effect of D/R heart size matching on survival and hemodynamics. Our main findings are as follows: (1) Recipients of donor hearts that are undersized according to DRWR have a statistically comparable outcome to recipients of size-matched or oversized hearts. (2) Recipients of donor hearts that are undersized according to DRWR have higher intracardiac filling pressures and lower CI early after transplantation, but the hemodynamic differences resolve with
Disclosure statement
The authors have no conflicts of interest to disclose.
References (28)
- et al.
National decline in donor heart utilization with regional variability: 1995-2010
Am J Transplant
(2015) - et al.
The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients
J Heart Lung Transplant
(2010) - et al.
Size matching in heart transplantation donor selection: “Too big to fail”?
J Heart Lung Transplant
(2017) - et al.
Cardiac size and sex-matching in heart transplantation: size matters in matters of sex and the heart
JACC Heart Fail
(2014) - et al.
Influence of donor and recipient sex mismatch on heart transplant outcomes: analysis of the International Society for Heart and Lung Transplantation Registry
J Heart Lung Transplant
(2012) - et al.
Functional and morphologic adaptation of undersized donor hearts after heart transplantation
J Am Coll Cardiol
(1995) - et al.
Weight is not an accurate criterion for adult cardiac transplant size matching
Ann Thorac Surg
(1991) - et al.
Predicted heart mass is the optimal metric for size match in heart transplantation
J Heart Lung Transplant
(2019) - et al.
The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung TransplantationThirty-fifth adult heart transplantation Report-2018; focus theme: multiorgan transplantation
J Heart Lung Transplant
(2018) - et al.
Early outcomes using hepatitis C-positive donors for cardiac transplantation in the era of effective direct-acting anti-viral therapies
J Heart Lung Transplant
(2018)
Increasing access to thoracic organs from donors infected with hepatitis C: A previous challenge-now an opportunity
J Heart Lung Transplant
Outcomes of donation After circulatory death heart transplantation in Australia
J Am Coll Cardiol
Donor-recipient size matching and mortality in heart transplantation: influence of body mass index and gender
J Heart Lung Transplant
Mechanical circulatory support and heart transplantation: donor and recipient factors influencing graft survival
Ann Thorac Surg
Cited by (17)
Is the practice of using oversized organs for recipients with elevated pulmonary vascular resistance justified?
2023, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Tang and colleagues13 showed that low DRWR does not negatively affect short- and long-term post-HTx survival in children. This has also been shown in adults.18 However, to our knowledge, the current study is the first analysis of how DRWR affects post-HTx survival in pediatric patients with varying levels of PVR (Figure 6).
No Evidence for Oversizing Hearts and Donor Size Impact on 1-Year Survival in Heart Failure Patients With Left Ventricular Assist Device
2023, American Journal of CardiologyInnovations in Heart Transplantation: A Review
2022, Journal of Cardiac FailureCitation Excerpt :Notably, 32% of the donor hearts declined owing to concerns for undersizing in the UNOS database between 2007 and 2016 would have been found to be acceptable using a predicted heart mass threshold.15 Although there have been mixed results on the potential risk of undersizing, a smaller study of 288 patients by Holzhauser et al16 found that undersizing based on multiple predictors affects early hemodynamics, but has no impact on the 1-year survival, suggesting that greater variability in donor heart size may be acceptable for transplantation. Further studies are needed to fully understand any potential complications of donor organ undersizing.
The Year in Cardiothoracic Transplantation Anesthesia: Selected Highlights from 2019
2020, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :The donor/recipient predicted heart mass was lowest in the undersized group. Although the undersized heart group had the highest postoperative filling pressures and the lowest cardiac index at 1 week, there were no significant differences in hemodynamics at 1 and 6 months or survival at 1 year.88 Attempts at sex- mismatched transplants have been shown to result in suboptimal outcomes.
Donor and Recipient Size Matching in Heart Transplantation With Predicted Heart and Lean Body Mass
2022, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :Importantly, we used different thresholds for oversized donors compared to previous studies and the associated risk, particularly in unadjusted analyses, was lower compared to the risk associated with donor undersizing. The mechanisms of increased risk in this group are not clear, but could be related to restrictive physiology or difficulties with chest closure.20 Additionally, we cannot exclude that unmeasured differences between patient groups are responsible for the difference in outcomes.