Donor left ventricular hypertrophy increases risk for early graft failure

Abstract

A review of factors contributing to early mortality after cardiac transplantation revealed that up to 25 % of deaths were due to primary graft dysfunction unrelated to rejection or infection. In light of this finding, evaluation of a donor heart with regard to its suitability for transplantation takes on added importance. In an effort to screen the suitability of donor hearts in the region covered by the Northwest Organ Procurement Agency (USA), all donors are evaluated by two-dimensional transthoracic echocardiography as part of the initial evaluation. A total of 110 donor echocardiograms were reviewed and an attempt was made to correlate the 30-day outcome with the parameters measured. An unexpected finding was that the presence of left ventricular hypertrophy in the donor heart was associated with an increase in the incidence of donor heart dysfunction compared with donors with normal echocardiographic profiles (33 % vs 3 %. P =-0.007).

Morphometric changes of the right ventricle in the first two weeks after clinical heart transplantation: analysis of myocardial biopsies from patients with complicated versus uncomplicated course

“…The pathological significance of this hypertrophy has not been totally examined in different recipient groups with a different postoperative outcome. Chronic hypertrophy can cause cardiomyopathy with an increased risk for myocardial ischemia and arrhythmia [25,26]. The reasons for the development of hypertrophy are not completely examined, but elevated right ventricular end-diastolic pressures in pulmonary hypertension may contribute.…”

Use of Cardiac Allografts With Mild and Moderate Left Ventricular Hypertrophy Can Be Safely Used in Heart Transplantation to Expand the Donor Pool

“…There is little data regarding HTx of donor hearts with LVH (8,9). Ͼ11 mm).This study demonstrated that the presence of donor LVH increased the incidence of early graft dysfunction (9). In contrast to these 2 reports, our study has a significantly larger number of recipients with donor LVH and importantly had a quantative assessment of LVWT.…”

“…Donor availability remains the main limiting factor in heart transplantation; as a result, approximately 2,000 transplants are performed annually in the U.S. (1). There is little data regarding HTx of donor hearts with LVH (8,9). Ͼ11 mm).This study demonstrated that the presence of donor LVH increased the incidence of early graft dysfunction (9).…”

“…Until recently, only 2 small studies have been published and found that the presence of LVH in the donor heart was associated with early graft dysfunction and lower survival (8,9). Moreover, there are no data regarding the changes in measured wall thickness after HTx in this patient population.…”

Impact of donor quality on outcome of heart transplantation☆☆☆

“…The comparison of the results showed a marked reduction in 1-(66% vs 82%) and 5-year survival (48% vs 68%). Their conclusion was that donor age should be restricted at 40 years and that left ventricular hypertrophy should always be regarded as a consistent risk factor in the heart donor due to its impact on mortality rate [18]. Nonetheless, Goland et al investigated the clinical course of patients receiving grafts from donors affected by left ventricular hypertrophy.…”