Impact of donor left ventricular hypertrophy on survival after heart transplant

Abstract

Left ventricular hypertrophy (LVH) of the donor heart is believed to increase the risk of allograft failure after transplant. However this effect is not well quantified, with variable findings from single-center studies. The United Network for Organ Sharing database was used to analyze the effect of donor LVH on recipient survival. Three cohorts, selected in accordance with the American Society of Echocardiography guidelines, were examined: recipients of allografts without LVH (<1.1 cm), with mild LVH (1.1-1.3 cm) and with moderate-severe LVH (≥ 1.4 cm). The study group included 2626 patients with follow-up of up to 3.3 years. Mild LVH was present in 38% and moderate-severe LVH in 5.6% of allografts. Predictors of mortality included a number of donor and recipient characteristics, but not LVH. However, a subgroup analysis showed an increased risk of death in recipients of allografts with LVH and donor age >55 years, and in recipients of allografts with LVH and ischemic time ≥ 4 h. In the contemporary era, close to half of all transplanted allografts demonstrate LVH, and survival of these recipients is similar to those without LVH. However, the use of allografts with LVH in association with other high-risk characteristics may result in increased mortality.

©Copyright 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1. Survival of recipients of allografts with no LVH, mild LVH and moderate or severe LVH

Recipients of allografts with left ventricular hypertrophy (LVH) had a similar survival for up to 3 years, compared with recipients of allografts without LVH.

Figure 2. Hazard ratios for death in recipients of allografts with no LVH, mild LVH and moderate or severe LVH, in relation to donor age and allograft ischemic time

(A) Recipients of allografts with mild LVH and donor age >55 years experienced six- to sevenfold increase in the risk of death. (B) Increased mortality risk was not seen in recipients of younger donors. (C) Recipients of donors with moderate or severe LVH and ischemic time ≥4 h had a hazard ratio for mortality >2. (D) Increased risk of death was not seen in recipients of allografts with LVH and allograft ischemic times

Figure 3. Effect of donor age on posttransplant survival of recipients of allografts with and without LVH

(A) Survival of recipients of allografts with LVH and donor age ≤ 55 years is similar to recipients of allografts without LVH. (B) In older donors, the use of allografts with LVH is associated with worse posttransplant survival compared with recipients of allografts without LVH.

Figure 4. Effect of ischemic time on posttransplant survival of recipients of allografts with and without LVH

(A) Survival of recipients of allografts with LVH and shorter ischemic time is similar to recipients of allografts without LVH. (B) Survival of recipients of allografts with moderate or severe LVH and prolonged ischemic time is worse than the survival of recipients of allografts without LVH.