Abstract 17435: Undersizing Donor Hearts by Predicted Heart Mass Increases the Risk of Primary Graft Dysfunction Following Cardiac Tranplantation
Background: Lingering theoretical concern over the hazards of significantly undersized donor hearts has impeded the utilization of otherwise viable allografts for transplantation. Prior studies indicate that predicted heart mass (pHM) provides better size matching in cardiac transplantation than body weight. We examined whether undersizing donor hearts by >30% pHM was associated with primary graft dysfunction (PGD), using the recent ISHLT definition.
Methods: Using a prospectively maintained clinical database, we reviewed 214 isolated heart transplants at a single institution and compared patients implanted with hearts undersized by >30% versus those implanted with normal donor size hearts within 30% of pHM (control group). Multivariate logistic regression was performed to assess the impact of donor undersizing on the development of mild, moderate, or severe PGD, and in-hospital/30-day mortality.
Results: The 2 groups were similar in age (56±12 years), history of prior sternotomy (50%), pulmonary vascular resistance (2 Woods units), and ischemic etiology (48%). Significant differences in the undersized vs control groups included a greater proportion of male recipients (100% vs 72%, P<0.0001), and greater body mass index (31 vs 28 kg/m2, P=0.005). In-hospital/30-day mortality was similar between groups (2.7% vs 3.4%). Overall, the undersized group experienced higher rates of PGD (41% vs 27%) as well as significantly increased rates of moderate/severe PGD (24% vs 9%; P=0.02; Figure 1). Multivariate analysis confirmed that undersizing donor hearts by pHM, but not by donor weight, was predictive of moderate/severe PGD (Odds ratio, 3.1 [95%-CI, 1.2-9.0], P=0.0036).
Conclusions: Undersized donor hearts by >30% according to pHM may increase rates of PGD following cardiac transplantation. This study confirms that pHM provides more clinically appropriate size matching than weight alone.
Author Disclosures: B. Lima: None. J. Collier: None. J. Felius: None. H. Ju: None. S. Hall: None. G. Gonzalez-Stawinski: None.
- © 2016 by American Heart Association, Inc.