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CLINICAL RESEARCH: CARDIAC TRANSPLANTATION

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

Sorel Goland, MD, Lawrence S.C. Czer, MD^_*,_*, Robert M. Kass, MD, Robert J. Siegel, MD^_*, James Mirocha, MS, Michele A. De Robertis, RN, Jason Lee, BS, Sharo Raissi, MD, Wen Cheng, MD, Gregory Fontana, MD and Alfredo Trento, MD

^_* Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
Division of Cardiology, Kaplan Medical Center, Rehovot, Israel.

Manuscript received July 12, 2007; revised manuscript received October 26, 2007, accepted November 12, 2007.

^_* Reprint requests and correspondence: Dr. Lawrence S. C. Czer, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room 6215, Los Angeles, California 90048. (Email: Lawrence.Czer{at}cshs.org).

Objectives: The purpose of this study was to evaluate outcomes of heart transplantation (HTx) and changes in left ventricular wall thickness (LVWT) post-HTx using donors with left ventricular hypertrophy (LVH).

Background: Limited data are available on use of donor hearts with LVH in HTx.

Methods: We reviewed 427 patients who underwent HTx: 62 received hearts with LVH (interventricular septum [IVS] or posterior wall [PW] thickness 1.2 cm) by echocardiography, and 365 received hearts without LVH. The median follow-up was 3.8 years (range 0 to 16.2 years).

Results: Recipient age was 56 ± 11 years and donor age was 30 ± 12 years. Baseline recipient characteristics were similar in both groups. Donors with LVH were older (35 ± 12 years vs. 29 ± 12 years, p = 0.001) and had higher rates of intracranial hemorrhage (38% vs. 15%, p = 0.001). The LVWT was increased in the LVH group compared with LVWT in the non-LVH group (IVS: 1.28 ± 0.18 cm vs. 0.85 ± 0.19 cm, PW: 1.27 ± 0.19 cm vs. 0.85 ± 0.20 cm, p = 0.0001 for both groups). Mild LVH (1.2 to 1.3 cm) was found in 42%, moderate (>1.3 to 1.7 cm) in 53%, and severe (>1.7 cm) in 5% of donors with LVH. Left ventricular wall thickness regression occurred in both IVS and PW (1.28 ± 0.18 cm vs. 1.10 ± 0.13 cm vs. 1.13 ± 0.14 cm, and 1.27 ± 0.19 cm vs. 1.11 ± 0.11 cm vs. 1.13 ± 0.14 cm, at baseline, 1 year, and 5 years, respectively; p < 0.001 for change from baseline to 1 and 5 years for both locations). Patients with or without donor LVH had similar 1-year (3.5% vs. 9.5%, p = 0.2) and 5-year survival rates (84 ± 5.9% vs. 70 ± 2.7%, p = 0.07).

Conclusions: Short- and long-term survival rates and rates of LVH at follow-up were similar in both groups, suggesting that donor hearts with mild and moderate LVH can be safely used in HTx.

Abbreviations and Acronyms   ACEI = angiotensin-converting enzyme inhibitor   ARB = angiotensin receptor blocker   HTN = hypertension   HTx = heart transplantation   IVS = interventricular septum   LV = left ventricular   LVH = left ventricular hypertrophy   LVWT = left ventricular wall thickness   PW = posterior wall