- 作者：B.A. Whitson ; Y. Ravi ; A. Kilic ; A. Hasan ; V. Franco ; R.S.D. Higgins ; C. Sai-Sudhakar
- 刊名：The Journal of Heart and Lung Transplantation
- 出版年：2013
- 出版时间：April, 2013
- 年：2013
- 卷：32
- 期：4_supp_S
- 页码：S14
- 全文大小：130 K
Purpose
In patients with pulmonary hypertension (PH) who undergo heart transplantation (HTX), recipients tend to be matched with taller donors in order to improve outcomes. In patients who have left ventricular assist devices (LVAD) and PH, the impact of oversizing is unknown.Methods and Materials
We evaluated the United Network for Organ Sharing registry of HTX recipients. We included adult recipients with LVAD at the time of transplantation. PH was defined as systolic pulmonary artery pressure >35mmHg. A donor >10.2cm taller than recipient was called Oversized. A donor >10.2cm shorter than recipient was called Undersized. All others were Matched. Standard statistical methods were used. Survival evaluated via the Kaplan-Meier method.
Results
We identified 2013 HTX recipients who met the inclusion criteria. Of recipients, 73.6 % were Matched, 13.9 % Oversized, and 12.5 % Undersized. By Kaplan-Meier analysis, Oversized trended toward a worse survival (p=0.16 when compared to Matched and Undersized, p=0.06 when compared to Undersized). [] At 30 days post-transplant, 95.2 % of Undersized and 88.3 % of Oversized recipients were alive, p=.005. At 1 year, 73.1 % of Undersized and 63 % of Oversized recipients were alive, p=0.015. Proportional hazard analysis of limited covariates demonstrated a significantly negative impact on survival by a male heart into a female recipient, increasing donor age and ischemic time.
Conclusions
In HTX recipients with PH and a LVAD at time of transplant, Oversizing donors does not impart a survival advantage and may in fact be detrimental. LVAD related anatomic changes may account for this observation. The impact of other donor specific variables may contribute or mitigate this effect on outcomes.