Donor Left Ventricular Hypertrophy: Over-Rated or Does Donor History of Hypertension Make a Difference for Post-Heart Transplant Outcome?

Abstract

Purpose Donor left ventricular hypertrophy (LVH) defined as either the interventricular septum (IVS) or posterior wall (PW) > 1.2 cm has been a concern for donor heart acceptance for transplantation. Cardio-pulmonary resuscitation (CPR) with chest compressions may also cause edema within the IVS and PW. It is not clear whether LVH due to a history of hypertension (HTN) in the donor or LVH due to edema from CPR have the same outcome after heart transplantation. Methods Between 2014 and 2017, we assessed 54 heart donors with LVH > 1.2 cm. We divided these donor hearts into those with a history of HTN (n=19) and those without (n=35). Post-operatively, we assessed for the presence of primary graft dysfunction (PGD), 1-year freedom from any-treated rejection (ATR), acute cellular rejection (ACR), and antibody-mediated rejection (AMR), 1-year freedom from cardiac allograft vasculopathy (CAV) as defined by stenosis ≥ 30% by angiography, and 1-year survival. We also assessed for the persistence of LVH at 6 and 12 months post-transplantation. Results There was no significant difference between LVH donors with and without a history of HTN in PGD, 1-year survival and 1-year freedom from CAV, ATR, ACR and AMR. LVH donors with HTN were older than those without HTN. LVH in donors with and without a history of HTN resulted in similar rates of LVH persistence at 6 and 12 months after transplantation. The persistence of LVH at 1 year was similar between the groups. (see table) Conclusion Donor heart LVH and history of HTN does not increase the risk of poor outcome after heart transplantation. Acceptable survival and resolution of LVH (occurs in most patients) indicates that LVH is well tolerated and may not be a concern in donor heart selection. Larger studies will be needed to confirm these findings.