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Oversized donor heart transplantation—clinical experience with an underestimated problem

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, India

    Srikanth Kasturi, Thiruthani Kumaran, Varun Shetty, Julius Punnen, Venkat Rao Parachuri & Devi Prasad Shetty

  2. Consultant Cardiothoracic and Heart Transplant Surgeon, Narayana Institute of Cardiac Sciences, 258/A, Hosur Road, Bommasandra Industrial Area, Anekal Taluk, Bengaluru, Karnataka, 560099, India

    Thiruthani Kumaran

  3. Department of Cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, India

    Shashiraj Subramanya & Bagirath Raghuraman

Authors
  1. Srikanth Kasturi
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  2. Thiruthani Kumaran
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  3. Varun Shetty
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  4. Julius Punnen
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  5. Shashiraj Subramanya
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  6. Bagirath Raghuraman
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  7. Venkat Rao Parachuri
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  8. Devi Prasad Shetty
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Contributions

All authors contributed to the study conception. The first draft of the manuscript was written by Srikanth Kasturi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Thiruthani Kumaran.

Ethics declarations

Ethics approval

The Narayana Health Academic Ethics Committee (NHAEC) approved the conduct of this study (letter no. NHH/AEC-CL-2020-509 dated 10.06.2020).

Informed consent

As this is a retrospective study, the need to obtain informed consent was waived off by the institutional ethics committee.

Statement of human and animal rights

There was no infringement of human or animal rights in this study.

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The authors declare no competing interests.

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Kasturi, S., Kumaran, T., Shetty, V. et al. Oversized donor heart transplantation—clinical experience with an underestimated problem. Indian J Thorac Cardiovasc Surg 37, 631–638 (2021). https://doi.org/10.1007/s12055-021-01200-6

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  • DOI: https://doi.org/10.1007/s12055-021-01200-6

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