The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report — 2019; focus theme: Donor and recipient size match

Abstract

The field of heart transplantation continues to evolve, with major changes in allocation systems and the increasing use of extended-criteria donor hearts, including hearts from donation after circulatory death donors, hearts supported with ex-vivo perfusion, and hearts from hepatitis C viremic donors. The use of such non-traditional donor hearts has made transplantation available to a larger number of recipients, but the demand continues to outpace the supply. Given this persistent donor heart shortage, much attention has been paid to the topic of donor-recipient size matching. Prior studies have challenged traditional criteria for size matching, 1-3 while others have attempted to identify the optimal metric for matching donor and recipient heart size by comparing criteria, such as height, weight, body mass index (BMI), body surface area (BSA), and predicted heart mass (PHM). [4][5][6][7] This 36th annual adult heart transplant report is based on data submitted to the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Transplant Registry on 146,975 heart transplants in recipients of all ages (including 131,249 adult heart transplants)

An early investigation of outcomes with the new 2018 donor heart allocation system in the United States

“…The findings of our early analysis into the implications of the current change in the US allocation system for donor heart organs suggest that although waitlist mortality has been reduced, post-transplantation outcomes may have worsened considerably. As waitlist mortality in the previous system was relatively low, 4 the absolute impact of this reduction in waitlist mortality is small compared with the increase in death or graft loss after transplantation, as is being observed in this early examination of the new system. The analysis also demonstrates important epidemiological shifts in the bridging strategies that are now predominantly focused on temporary mechanical circulatory support devices.…”

Transcatheter aortic valve replacement 24 years after cardiac transplantation

“…After the first year, the survival rate declines in a linear fashion at approximately 3.4% per year 10 . This, in turn, has resulted in a significant population surviving beyond the median survival time of 12.5 years 11 . As such, a large number of cardiac transplantation patients will eventually face late complications such as coronary artery disease and valvular lesions.…”

Exercise after Heart Transplantation: Typical Alterations, Diagnostics and Interventions

“…The survival rates after one, five, and ten years are currently approx. 85,75, and 60 %, respectively [6,7]. With these survival times, the optimum build-up of exercise capacity and functional performance is therefore crucial.…”

“…Thieme Review survivors [7]. About 75 % of all recipients are male with a mean age at transplantation of 55 years.…”

“…About 75 % of all recipients are male with a mean age at transplantation of 55 years. However, the age range for recipients is quite large, with 30 % of patients younger than 40 years and 30 % of patients older than 60 years, leading to different physical overall prerequisites [7].…”