Oversized donor heart transplantation—clinical experience with an underestimated problem

Kasturi, Srikanth; Kumaran, Thiruthani; Shetty, Varun; Punnen, Julius; Subramanya, Shashiraj; Raghuraman, Bagirath; Parachuri, V Rao; Shetty, Devi Prasad

doi:10.1007/s12055-021-01200-6

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…This could predispose them to having compromised hemodynamics in the early postoperative period or need for delayed chest closure. 16 While these events are not currently tracked by the SRTR database, it is possible that they contributed in part to the worse early outcomes observed in very short-stature patients including postoperative renal failure and 30-day mortality. Another explanation for short stature's association with poor outcomes is that—in a minority of cases—short stature is caused by genetic or developmental diseases, which themselves predispose patients to higher post-transplant risk.…”

Section: Discussionmentioning

confidence: 99%

Short stature is a risk factor for heart transplant morbidity and mortality

Weingarten,

Iyengar,

Patel

et al. 2023

Asian Cardiovasc Thorac Ann

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Background Short stature is associated with mortality after cardiac surgery and may increase size mismatch risk among transplant recipients. Yet, stature's impact on heart transplant outcomes is not well-characterized. Methods The Scientific Registry of Transplant Recipients was queried for data on all adult heart transplants in the United States from 2000 to 2022. Recipients were stratified into five cohorts by sex-corrected stature. Morbidity was assessed with Kruskal–Wallis and chi-squared tests. Mortality was analyzed using Kaplan–Meier estimation. Risk factors for mortality were assessed with multivariable Cox regression. Results Among 43,420 transplant recipients, 5321 (12.2%) had short stature (females >4′11″ & ≤5′1″; males >5′4″ & ≤5′7″) and 765 (1.8%) had very short stature (females ≤4′11″; males ≤5′4″). Very short stature patients had higher waitlist status (1A and 1), more congenital heart disease, and received more oversized donor hearts than other cohorts (all p < 0.05). Very short stature patients had decreased 30-day, 1-, 5-, and 10-year survival (94.6%, 84.3%, 69.3% and 52.5%, respectively, all p < 0.001), but less acute rejection ( p = 0.005) and comparable stroke rates ( p = 0.107). On multivariable regression adjusting for congenital heart disease and oversized donor hearts, very short and short stature were associated with 10-year mortality (hazard ratios: 1.40 and 1.12, respectively, both p < 0.005). Conclusions Short stature confers increased mortality risk for heart transplant recipients and merits inclusion in prognostic models.

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Section: Discussionmentioning

confidence: 99%

Short stature is a risk factor for heart transplant morbidity and mortality

Weingarten,

Iyengar,

Patel

et al. 2023

Asian Cardiovasc Thorac Ann

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“…There is no consensus on the effect of the latter on patient survival. On the one hand, some studies do not find differences in events during hospitalization and in the short-term outcomes [11], while others find an increase in one-year mortality after transplantation [12].…”

Section: Graft Sizementioning

confidence: 99%

Heart Transplantation

Chrysakis,

Magouliotis,

Spiliopoulos

et al. 2024

JCM

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Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results.

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“…Preoperative organ size matching is important for both allogeneic and xenogeneic heart transplantation since both over‐ and underestimation may jeopardize the success of the procedure. Whereas oversizing mainly complicates surgery due to the excessive size of the donor organs’ anatomical structures, 1 severe undersizing also has a negative impact on patient survival 2 . The current International Society for Heart and Lung Transplantation (ISHLT) recommendations for (allogeneic) organ allocation are based on the total body weight (TBW) difference between donors and recipients, defining that the donor's weight must be at least 70% of the recipient's weight 3 .…”

Section: Introductionmentioning

confidence: 99%

Transthoracic echocardiography is a simple tool for size matching in cardiac xenotransplantation

Mokelke,

Bender,

Reichart

et al. 2024

Xenotransplantation

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BackgroundPreoperative size matching is essential for both allogeneic and xenogeneic heart transplantation. In preclinical pig‐to‐baboon xenotransplantation experiments, porcine donor organs are usually matched to recipients by using indirect parameters, such as age and total body weight. For clinical use of xenotransplantation, a more precise method of size measurement would be desirable to guarantee a “perfect match.” Here, we investigated the use of transthoracic echocardiography (TTE) and described a new method to estimate organ size prior to xenotransplantation.MethodsHearts from n = 17 genetically modified piglets were analyzed by TTE and total heart weight (THW) was measured prior to xenotransplantation into baboons between March 2018 and April 2022. Left ventricular (LV) mass was calculated according to the previously published method by Devereux et al. and a newly adapted formula. Hearts from n = 5 sibling piglets served as controls for the determination of relative LV and right ventricular (RV) mass. After explantation, THW and LV and RV mass were measured.ResultsTHW correlated significantly with donor age and total body weight. The strongest correlation was found between THW and LV mass calculated by TTE. Compared to necropsy data of the control piglets, the Devereux formula underestimated both absolute and relative LV mass, whereas the adapted formula yielded better results. Combining the adapted formula and the relative LV mass data, THW can be predicted with TTE.ConclusionsWe demonstrate reliable LV mass estimation by TTE for size matching prior to xenotransplantation. An adapted formula provides more accurate results of LV mass estimation than the generally used Devereux formula in the xenotransplantation setting. TTE measurement of LV mass is superior for the prediction of porcine heart sizes compared to conventional parameters such as age and total body weight.

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Oversized donor heart transplantation—clinical experience with an underestimated problem

Cited by 8 publications

References 22 publications

Short stature is a risk factor for heart transplant morbidity and mortality

Short stature is a risk factor for heart transplant morbidity and mortality

Heart Transplantation

Transthoracic echocardiography is a simple tool for size matching in cardiac xenotransplantation

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