Transplant Outcomes in Hearts with Moderate to Severe Left Ventricular Hypertrophy After the 2018 OPTN/UNOS Allocation Changes

Abstract

<h3>Purpose</h3> After the 2018 OPTN/UNOS heart transplant (HT) allocation changes, there has been an increase in graft ischemia time, a factor shown to worsen HT outcomes in recipients of hearts with left ventricular hypertrophy (LVH). We compare HT outcomes in moderate to severe LVH defined by left ventricular wall thickness ≥ 1.4cm and non-LVH hearts and determine if there were changes in LVH HT outcomes after 2018. <h3>Methods</h3> The UNOS database was queried for all HT recipients ages >18 from 2016 to 2020. Multi-organ transplants were excluded. Demographic, donor, and recipient information were compared between LVH and non-LVH hearts. The primary outcome was post-transplant survival with secondary outcomes of rejection, cardiac allograft vasculopathy (CAV), and post-transplant ejection fraction, all at one year. Comparisons were made using Chi-squared and Wilcoxon rank-sum. Multiple logistic and linear regression models were used to discern the predictors of survival and the effect of LVH on outcomes. <h3>Results</h3> 10,175 HTs were analyzed: 491 LVH and 9784 non-LVH. After the 2018 changes, compared to non-LVH HT donors, LVH HT donors were older, had higher BMI, more often had HTN, were male, and had kidney disease. LVH HT recipients were older, higher BMI, and had greater HLA mismatch. Graft ischemia time, survival, and secondary outcomes were similar. Examining the LVH cohort specifically before and after the 2018 changes, there were no differences in survival or most secondary outcomes (decrease in CAV) despite increases in recipient BMI, recipient prior cardiac surgery, and graft ischemia time, which were independent predictors of worse outcomes in the overall cohort. LVH was not a predictor of survival or any secondary outcome. <h3>Conclusion</h3> Outcomes for recipients of hearts with moderate to severe LVH were not negatively impacted by the 2018 OPTN/UNOS changes despite longer graft ischemia time, and outcomes for recipients of LVH hearts were similar to those receiving hearts without LVH.