Outcome in Cardiac Recipients of Donor Hearts With Increased Left Ventricular Wall Thickness

The ongoing shortage of donors for cardiac transplantation has led to a trend toward acceptance of donor hearts with some structural abnormalities including left ventricular hypertrophy. To evaluate the outcome in recipients of donor hearts with increased left ventricular wall thickness (LVWT), we r...

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Bibliographic Details
Published in:	American journal of transplantation Vol. 7; no. 10; pp. 2388 - 2395
Main Authors:	Kuppahally, S. S., Valantine, H. A., Weisshaar, D., Parekh, H., Hung, Y. Y., Haddad, F., Fowler, M., Vagelos, R., Perlroth, M. G., Robbins, R. C., Hunt, S. A.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-10-2007 Blackwell
Subjects:	Adult Antihypertensive Agents - therapeutic use Biological and medical sciences Biopsy Cardiac donor Coronary Angiography Echocardiography Female Heart Transplantation - immunology Heart Transplantation - mortality Heart Transplantation - pathology Heart Transplantation - physiology Heart Ventricles - pathology Humans Immunosuppressive Agents - therapeutic use left ventricular hypertrophy Male Medical sciences Middle Aged Myocardium - pathology Patient Selection recipient Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases survival Survival Analysis Tissue and Organ Harvesting - methods Tissue Donors - statistics & numerical data Tissue Donors - supply & distribution Treatment Outcome vasculopathy Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - pathology Suboptimal donor Human Prognosis Cardiovascular disease Recipient Transplantation Wall thickness Survival Left ventricle Vascular disease Left heart Treatment left ventricular hypertrophy Surgery Graft Evolution vasculopathy Hypertrophy Cardiac donor
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Summary:	The ongoing shortage of donors for cardiac transplantation has led to a trend toward acceptance of donor hearts with some structural abnormalities including left ventricular hypertrophy. To evaluate the outcome in recipients of donor hearts with increased left ventricular wall thickness (LVWT), we retrospectively analyzed data for 157 cardiac donors and respective recipients from January 2001 to December 2004. There were 47 recipients of donor heart with increased LVWT ≥1.2 cm, which constituted the study group and 110 recipients of a donor heart with normal LVWT < 1.2 cm that formed the control group. At 3 ± 1.5 years, recipient survival was lower (50% vs. 82%, p = 0.0053) and incidence of allograft vasculopathy was higher (50% vs. 22%, p = 0.05) in recipients of donor heart with LVWT > 1.4 cm as compared to LVWT ≤ 1.4 cm. By Cox regression, donor LVWT > 1.4 cm (p = 0.003), recipient preoperative ventricular assist device (VAD) support (p = 0.04) and bypass time > 150 min (p = 0.05) were predictors of reduced survival. Our results suggest careful consideration of donor hearts with echocardiographic evidence of increased LVWT in the absence of hypovolemia, because they may be associated with poorer outcomes; such hearts should potentially be reserved only for the most desperately ill recipients. Cardiac recipients of donor hearts with increased left ventricular wall thickness have a poor outcome.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1600-6135 1600-6143
DOI:	10.1111/j.1600-6143.2007.01930.x