346: Three-dimensional matrix embedding of endothelial cells abates alloimmunity via upregulation of CD4 +CD25 +Foxp3 + T regulatory cells

Abstract

Purpose: We evaluated outcomes of orthotopic heart transplantation (OHT) using donors with left ventricular hypertrophy (LVH) and assessed changes in LV wall thickness in patients who received a donor hearts with or without LVH. Methods and Materials: We reviewed 427 patients who had OHT: 62 received hearts with LVH (interventricular septum (IVS) or posterior wall (PW) thickness 12 mm) by echocardiography and 365 patients without donor LVH. Results: Mean recipient age was 56 11 and donor age 30 2 yrs. Recipient age, gender, UNOS status, indications for OHT, and hemodynamics were similar in both groups. Ischemic time 240 min occurred only in patients with LVH (6%, p 0.03). The mean donor age was greater in the LVH group (35 12 vs 29 12, p 0.001) and they had higher rates of intracranial hemorrhage (38% vs 15%), p 0.001). Other donor characteristics were similar. LV wall thickness (LVWT) was increased in the LVH group compared with non-LVH donors (IVS: 12.6 1.9 vs 8.5 1.1, PW: 12.7 1.0 vs 9.0 1.0 mm, p 0.0001). Mild LVH (LVWT 12-13 mm) was found in 42%, moderate ( 13-17 mm) in 53% and severe ( 17 mm) in 5% of donors. Median follow-up was 3.8 yrs (range 0 to 17 yrs). Significant regression of LVH occurred (IVS: -1.6 2.0 mm, p 0.0004, PW: -1.8 0.2 mm, p 0.001) at mean followup of 4 2 yrs. The mean IVS: 1.1 0.2 vs 1.1 0.1,p 0.2 , PW: 1.1 0.2 vs 1.1 0.1,p 0.5 and rates of patients with LVH (38% vs 32%, p 0.5) were similar in both groups at followup. Recipients of hearts with and without LVH had similar 30 day (1.6% vs. 3.3%, p 0.7) and 1 yr mortality (3.5% vs 9.5%,p 0.2). Long-term survival was similar in the two groups, p 0.11; survival estimates (7 yrs) were 66 1% vs 57 3%. The incidences of rejection and graft CAD were similar in the two groups. Multivariate analysis revealed no evidence that donor LVH was associated with increased mortality. Conclusions: Shortand long-term survival , LV wall thickness and rates of LVH at follow-up were similar in both groups, suggesting that donor hearts with mild and moderate LVH can be successfully used in OHT.