Outcomes Using Donor Hearts With Moderate To Severe Left Ventricular Hypertrophy After The 2018 OPTN/UNOS Allocation Changes

• Published in: Journal of cardiac failure Vol. 30; no. 1; p. 135
• Main Authors: Ramachandran, Abhinay, Siddiqui, Emaad, Moazami, Nader, Lonze, Bonnie, Reyentovich, Alex, James, Les, Saraon, Tajinderpal, Goldberg, Randal, Kadosh, Bernard, Katz, Stuart, Smith, Deane E., Gidea, Claudia
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.01.2024
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2023.10.045

There is a need for more data examining the outcomes of using donor hearts with moderate/severe left ventricular hypertrophy (LVH). This study aimed to assess the outcomes of using donor hearts with moderate/severe LVH and evaluate whether outcomes were affected by the 2018 OPTN/UNOS allocation changes. The UNOS database was queried for heart transplants occurring within one year of the October 18, 2018 OPTN/UNOS changes. Pre- and post-2018 changes cohorts were stratified by LVH: non-LVH (left ventricular wall thickness [LVWT] <= 1.1 cm), mild LVH (LVWT 1.2-1.3 cm), or moderate/severe LVH (LVWT ≥ 1.4 cm). The primary outcome was two-year mortality. The secondary outcomes were allograft rejection and cardiac allograft vasculopathy (CAV) at two years. Multivariate regression models were made for both the overall cohort and LVH cohorts. 4295 patients were analyzed. Mortality was similar across non-LVH (12%), mild LVH (12%), and moderate/severe LVH (15%) cohorts, p=0.589, including when non-LVH and moderate/severe LVH were directly compared (p=0.340). CAV (p=0.526) and rejection (p=0.675) were also similar across the three groups, including when non-LVH and moderate/severe LVH were directly compared (CAV: p=0.904; rejection: p=0.393). When a subgroup of moderate/severe LVH cohort with concomitant donor hypertension was compared against the non-LVH cohort, mortality p=0.163 and CAV p=0.680 were similar, with rejections significantly lower (7% vs. 23%, p=0.016). Outcomes for moderate/severe LVH remained similar after the 2018 changes: mortality (p=0.868), rejection (p=0.237), CAV (p=0.373). In multivariate regression for the overall cohort, moderate/severe LVH status was not associated with mortality (p=0.512), rejection (p=0.486), or CAV (p=0.563). In multivariate regression for the LVH cohort primary and secondary outcomes were not associated with LVWT (mortality: p=0.519; CAV: p=0.358; rejection: p=0.885) or the 2018 OPTN/UNOS allocation changes (mortality: p=0.372; CAV: p=0.096, rejection: p=0.086). Clinical outcomes at two years were similar among recipients of hearts with or without moderate/severe LVH. Outcomes in recipients of donor hearts with moderate/severe LVH remained similar following the 2018 OPTN/UNOS allocation changes.