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Oversized donor heart transplantation—clinical experience with an underestimated problem
Purpose Heart transplantation is the definitive treatment for end-stage heart failure. With respect to donor-recipient size matching, the problems with undersized heart transplantation have been widely discussed, but there is a paucity of information on oversized transplants due to the presumed adva...
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| Published in: | Indian journal of thoracic and cardiovascular surgery 2021-11, Vol.37 (6), p.631-638 |
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| Main Authors: | , , , , , , , |
| Format: | Article |
| Language: | English |
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| cited_by | cdi_FETCH-LOGICAL-c446t-8c1154a645323e99902e733e98bb221a95370ba2fbcb7998f8a5e810dc2e9d753 |
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| cites | cdi_FETCH-LOGICAL-c446t-8c1154a645323e99902e733e98bb221a95370ba2fbcb7998f8a5e810dc2e9d753 |
| container_end_page | 638 |
| container_issue | 6 |
| container_start_page | 631 |
| container_title | Indian journal of thoracic and cardiovascular surgery |
| container_volume | 37 |
| creator | Kasturi, Srikanth Kumaran, Thiruthani Shetty, Varun Punnen, Julius Subramanya, Shashiraj Raghuraman, Bagirath Parachuri, Venkat Rao Shetty, Devi Prasad |
| description | Purpose
Heart transplantation is the definitive treatment for end-stage heart failure. With respect to donor-recipient size matching, the problems with undersized heart transplantation have been widely discussed, but there is a paucity of information on oversized transplants due to the presumed advantage of large hearts. We intend to share our center’s experience with oversized heart transplantation and its associated problems which would help to expand the knowledge on oversized cardiac allografts.
Methods
Patients who underwent isolated heart transplantation at our hospital between March 1, 2008, and March 1, 2020, were included. For adults, a donor-recipient predicted heart mass percentage difference exceeding 30% and for children, a donor-recipient weight ratio 2.0 was considered a mismatch. We collected data from the in-patient medical records and analyzed the in-hospital outcomes and survival post-transplant among various other parameters.
Results
Out of the 43 patients included in this study, 32 (74.4%) patients received a matched heart and 11 (25.6%) patients received oversized hearts. None of the patients received an undersized heart. The in-hospital mortality rate of oversized transplants was 18.2% whereas that of matched transplants was 9.4% (
p
= 0.432). The post-operative characteristics and 1-year survival were comparable between the groups. We encountered problems specific to oversizing in 5 of the 11 patients (45.4%) which are discussed.
Conclusion
With the liberalization of donor criteria to overcome organ shortage, oversized heart transplantation poses certain unique challenges, which when efficiently managed offers acceptable outcomes. |
| doi_str_mv | 10.1007/s12055-021-01200-6 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8546007</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2597821223</sourcerecordid><originalsourceid>FETCH-LOGICAL-c446t-8c1154a645323e99902e733e98bb221a95370ba2fbcb7998f8a5e810dc2e9d753</originalsourceid><addsrcrecordid>eNp9UblOxTAQtBCI-wcoUEqagM84bpAQ4pKQaKChsRxnH88ozw52wlXxEXwhX4LhAYKGakfa2dnZHYS2CN4lGMu9RCgWosSUlDhDXFYLaBUryUopKVv8xLhUhPEVtJbSLcaMY06X0QrjUlZVRVbR9cU9xOSeoS3a4EMspmDiUAzR-NR3xg9mcMG_vbzaznlnTVfAYw_RgbdQPLhhWhhfjL6FCGlwMzNkoT6GpoPZBlqamC7B5lddR1fHR5eHp-X5xcnZ4cF5aTmvhrK2hAhuKi4YZaCUwhQky6huGkqJUYJJ3Bg6aWwjlaontRFQE9xaCqqVgq2j_bluPzYzaC347L7Tfcx24pMOxum_He-m-ibc61rwKv8xC-x8CcRwN-Y79MwlC10-H8KYNBVK1pRQyjKVzqk2hpQiTH7WEKw_QtHzUHQORX-Goqs8tP3b4M_IdwqZwOaElFv-BqK-DWP0-Wn_yb4Dx9ubNQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2597821223</pqid></control><display><type>article</type><title>Oversized donor heart transplantation—clinical experience with an underestimated problem</title><source>Open Access: PubMed Central</source><source>Springer Nature</source><creator>Kasturi, Srikanth ; Kumaran, Thiruthani ; Shetty, Varun ; Punnen, Julius ; Subramanya, Shashiraj ; Raghuraman, Bagirath ; Parachuri, Venkat Rao ; Shetty, Devi Prasad</creator><creatorcontrib>Kasturi, Srikanth ; Kumaran, Thiruthani ; Shetty, Varun ; Punnen, Julius ; Subramanya, Shashiraj ; Raghuraman, Bagirath ; Parachuri, Venkat Rao ; Shetty, Devi Prasad</creatorcontrib><description>Purpose
Heart transplantation is the definitive treatment for end-stage heart failure. With respect to donor-recipient size matching, the problems with undersized heart transplantation have been widely discussed, but there is a paucity of information on oversized transplants due to the presumed advantage of large hearts. We intend to share our center’s experience with oversized heart transplantation and its associated problems which would help to expand the knowledge on oversized cardiac allografts.
Methods
Patients who underwent isolated heart transplantation at our hospital between March 1, 2008, and March 1, 2020, were included. For adults, a donor-recipient predicted heart mass percentage difference exceeding 30% and for children, a donor-recipient weight ratio < 0.8 and > 2.0 was considered a mismatch. We collected data from the in-patient medical records and analyzed the in-hospital outcomes and survival post-transplant among various other parameters.
Results
Out of the 43 patients included in this study, 32 (74.4%) patients received a matched heart and 11 (25.6%) patients received oversized hearts. None of the patients received an undersized heart. The in-hospital mortality rate of oversized transplants was 18.2% whereas that of matched transplants was 9.4% (
p
= 0.432). The post-operative characteristics and 1-year survival were comparable between the groups. We encountered problems specific to oversizing in 5 of the 11 patients (45.4%) which are discussed.
Conclusion
With the liberalization of donor criteria to overcome organ shortage, oversized heart transplantation poses certain unique challenges, which when efficiently managed offers acceptable outcomes.</description><identifier>ISSN: 0970-9134</identifier><identifier>EISSN: 0973-7723</identifier><identifier>DOI: 10.1007/s12055-021-01200-6</identifier><identifier>PMID: 34776661</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Cardiac Surgery ; Medicine ; Medicine & Public Health ; Original ; Original Article ; Surgery ; Thoracic Surgery ; Vascular Surgery</subject><ispartof>Indian journal of thoracic and cardiovascular surgery, 2021-11, Vol.37 (6), p.631-638</ispartof><rights>Indian Association of Cardiovascular-Thoracic Surgeons 2021</rights><rights>Indian Association of Cardiovascular-Thoracic Surgeons 2021.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-8c1154a645323e99902e733e98bb221a95370ba2fbcb7998f8a5e810dc2e9d753</citedby><cites>FETCH-LOGICAL-c446t-8c1154a645323e99902e733e98bb221a95370ba2fbcb7998f8a5e810dc2e9d753</cites><orcidid>0000-0002-8537-660X ; 0000-0002-7367-5995 ; 0000-0001-9767-034X ; 0000-0003-4172-143X ; 0000-0002-8773-5901 ; 0000-0003-3120-5888</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546007/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546007/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34776661$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kasturi, Srikanth</creatorcontrib><creatorcontrib>Kumaran, Thiruthani</creatorcontrib><creatorcontrib>Shetty, Varun</creatorcontrib><creatorcontrib>Punnen, Julius</creatorcontrib><creatorcontrib>Subramanya, Shashiraj</creatorcontrib><creatorcontrib>Raghuraman, Bagirath</creatorcontrib><creatorcontrib>Parachuri, Venkat Rao</creatorcontrib><creatorcontrib>Shetty, Devi Prasad</creatorcontrib><title>Oversized donor heart transplantation—clinical experience with an underestimated problem</title><title>Indian journal of thoracic and cardiovascular surgery</title><addtitle>Indian J Thorac Cardiovasc Surg</addtitle><addtitle>Indian J Thorac Cardiovasc Surg</addtitle><description>Purpose
Heart transplantation is the definitive treatment for end-stage heart failure. With respect to donor-recipient size matching, the problems with undersized heart transplantation have been widely discussed, but there is a paucity of information on oversized transplants due to the presumed advantage of large hearts. We intend to share our center’s experience with oversized heart transplantation and its associated problems which would help to expand the knowledge on oversized cardiac allografts.
Methods
Patients who underwent isolated heart transplantation at our hospital between March 1, 2008, and March 1, 2020, were included. For adults, a donor-recipient predicted heart mass percentage difference exceeding 30% and for children, a donor-recipient weight ratio < 0.8 and > 2.0 was considered a mismatch. We collected data from the in-patient medical records and analyzed the in-hospital outcomes and survival post-transplant among various other parameters.
Results
Out of the 43 patients included in this study, 32 (74.4%) patients received a matched heart and 11 (25.6%) patients received oversized hearts. None of the patients received an undersized heart. The in-hospital mortality rate of oversized transplants was 18.2% whereas that of matched transplants was 9.4% (
p
= 0.432). The post-operative characteristics and 1-year survival were comparable between the groups. We encountered problems specific to oversizing in 5 of the 11 patients (45.4%) which are discussed.
Conclusion
With the liberalization of donor criteria to overcome organ shortage, oversized heart transplantation poses certain unique challenges, which when efficiently managed offers acceptable outcomes.</description><subject>Cardiac Surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original</subject><subject>Original Article</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Vascular Surgery</subject><issn>0970-9134</issn><issn>0973-7723</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9UblOxTAQtBCI-wcoUEqagM84bpAQ4pKQaKChsRxnH88ozw52wlXxEXwhX4LhAYKGakfa2dnZHYS2CN4lGMu9RCgWosSUlDhDXFYLaBUryUopKVv8xLhUhPEVtJbSLcaMY06X0QrjUlZVRVbR9cU9xOSeoS3a4EMspmDiUAzR-NR3xg9mcMG_vbzaznlnTVfAYw_RgbdQPLhhWhhfjL6FCGlwMzNkoT6GpoPZBlqamC7B5lddR1fHR5eHp-X5xcnZ4cF5aTmvhrK2hAhuKi4YZaCUwhQky6huGkqJUYJJ3Bg6aWwjlaontRFQE9xaCqqVgq2j_bluPzYzaC347L7Tfcx24pMOxum_He-m-ibc61rwKv8xC-x8CcRwN-Y79MwlC10-H8KYNBVK1pRQyjKVzqk2hpQiTH7WEKw_QtHzUHQORX-Goqs8tP3b4M_IdwqZwOaElFv-BqK-DWP0-Wn_yb4Dx9ubNQ</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>Kasturi, Srikanth</creator><creator>Kumaran, Thiruthani</creator><creator>Shetty, Varun</creator><creator>Punnen, Julius</creator><creator>Subramanya, Shashiraj</creator><creator>Raghuraman, Bagirath</creator><creator>Parachuri, Venkat Rao</creator><creator>Shetty, Devi Prasad</creator><general>Springer Singapore</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8537-660X</orcidid><orcidid>https://orcid.org/0000-0002-7367-5995</orcidid><orcidid>https://orcid.org/0000-0001-9767-034X</orcidid><orcidid>https://orcid.org/0000-0003-4172-143X</orcidid><orcidid>https://orcid.org/0000-0002-8773-5901</orcidid><orcidid>https://orcid.org/0000-0003-3120-5888</orcidid></search><sort><creationdate>20211101</creationdate><title>Oversized donor heart transplantation—clinical experience with an underestimated problem</title><author>Kasturi, Srikanth ; Kumaran, Thiruthani ; Shetty, Varun ; Punnen, Julius ; Subramanya, Shashiraj ; Raghuraman, Bagirath ; Parachuri, Venkat Rao ; Shetty, Devi Prasad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-8c1154a645323e99902e733e98bb221a95370ba2fbcb7998f8a5e810dc2e9d753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cardiac Surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original</topic><topic>Original Article</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kasturi, Srikanth</creatorcontrib><creatorcontrib>Kumaran, Thiruthani</creatorcontrib><creatorcontrib>Shetty, Varun</creatorcontrib><creatorcontrib>Punnen, Julius</creatorcontrib><creatorcontrib>Subramanya, Shashiraj</creatorcontrib><creatorcontrib>Raghuraman, Bagirath</creatorcontrib><creatorcontrib>Parachuri, Venkat Rao</creatorcontrib><creatorcontrib>Shetty, Devi Prasad</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Indian journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kasturi, Srikanth</au><au>Kumaran, Thiruthani</au><au>Shetty, Varun</au><au>Punnen, Julius</au><au>Subramanya, Shashiraj</au><au>Raghuraman, Bagirath</au><au>Parachuri, Venkat Rao</au><au>Shetty, Devi Prasad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Oversized donor heart transplantation—clinical experience with an underestimated problem</atitle><jtitle>Indian journal of thoracic and cardiovascular surgery</jtitle><stitle>Indian J Thorac Cardiovasc Surg</stitle><addtitle>Indian J Thorac Cardiovasc Surg</addtitle><date>2021-11-01</date><risdate>2021</risdate><volume>37</volume><issue>6</issue><spage>631</spage><epage>638</epage><pages>631-638</pages><issn>0970-9134</issn><eissn>0973-7723</eissn><abstract>Purpose
Heart transplantation is the definitive treatment for end-stage heart failure. With respect to donor-recipient size matching, the problems with undersized heart transplantation have been widely discussed, but there is a paucity of information on oversized transplants due to the presumed advantage of large hearts. We intend to share our center’s experience with oversized heart transplantation and its associated problems which would help to expand the knowledge on oversized cardiac allografts.
Methods
Patients who underwent isolated heart transplantation at our hospital between March 1, 2008, and March 1, 2020, were included. For adults, a donor-recipient predicted heart mass percentage difference exceeding 30% and for children, a donor-recipient weight ratio < 0.8 and > 2.0 was considered a mismatch. We collected data from the in-patient medical records and analyzed the in-hospital outcomes and survival post-transplant among various other parameters.
Results
Out of the 43 patients included in this study, 32 (74.4%) patients received a matched heart and 11 (25.6%) patients received oversized hearts. None of the patients received an undersized heart. The in-hospital mortality rate of oversized transplants was 18.2% whereas that of matched transplants was 9.4% (
p
= 0.432). The post-operative characteristics and 1-year survival were comparable between the groups. We encountered problems specific to oversizing in 5 of the 11 patients (45.4%) which are discussed.
Conclusion
With the liberalization of donor criteria to overcome organ shortage, oversized heart transplantation poses certain unique challenges, which when efficiently managed offers acceptable outcomes.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>34776661</pmid><doi>10.1007/s12055-021-01200-6</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8537-660X</orcidid><orcidid>https://orcid.org/0000-0002-7367-5995</orcidid><orcidid>https://orcid.org/0000-0001-9767-034X</orcidid><orcidid>https://orcid.org/0000-0003-4172-143X</orcidid><orcidid>https://orcid.org/0000-0002-8773-5901</orcidid><orcidid>https://orcid.org/0000-0003-3120-5888</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Indian journal of thoracic and cardiovascular surgery, 2021-11, Vol.37 (6), p.631-638 |
| issn | 0970-9134 0973-7723 |
| language | eng |
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| source | Open Access: PubMed Central; Springer Nature |
| subjects | Cardiac Surgery Medicine Medicine & Public Health Original Original Article Surgery Thoracic Surgery Vascular Surgery |
| title | Oversized donor heart transplantation—clinical experience with an underestimated problem |
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