title: Domino heart transplantation: long-term outcome of recipients and their living donors: single center experience.
abstract: BACKGROUND
  "Domino" cardiac procedure is an effective option to increase the donor pool when heart-lung transplantation (HLT) is the only treatment for patients with terminal cardiopneumopathy. We reviewed the long-term outcomes of domino cardiac donors and recipients at our institution.
  
  
  METHODS
  Ten of 35 patients who underwent HLT from 1991 onward served as domino cardiac donors. They included eight female and two male subjects of overall mean age of 33 years and mean weight of 55 kg. Their diagnoses were primary pulmonary hypertension (n = 6) as well as cystic fibrosis, bronchiectasis, Eisenmenger's syndrome, and bronchiolitis obliterans (n = 1 each). The domino cardiac recipients included six males and four females of overall mean age of 47 years and mean weight of 61 kg. They were affected by ischemic heart disease (n = 5), cardiomyopathy (n = 4), and valvular heart disease (n = 1). Mean pulmonary vascular resistance was 3 Wood units. The heart was used either in the orthotopic (n = 8) or in the heterotopic position (n = 2).
  
  
  RESULTS
  The 1-, 5-, and 10-year survivals for the domino cardiac donors versus their recipients were 60%, 40%, 30% versus 90%, 70%, 60%, respectively. Five domino donors developed bronchiolitis obliterans syndrome. Among the domino recipients group, cardiac allograft vasculopathy was rare (n = 1). Common causes of late death were in the domino recipients infections in the domino donors (n = 2) and malignancies.
  
  
  CONCLUSIONS
  Our experience suggested good long-term results of the domino procedure.
authors.affiliation: Cardiovascular Department, Cardiac Surgery Unit, IRCCS Istituto Clinico Humanitas, Rozzano (MI), Italy. giuseppe.raffa78@gmail.com
authors.forename: G M
authors.initials: GM
authors.lastname: Raffa
authors.forename: C
authors.initials: C
authors.lastname: Pellegrini
authors.forename: M
authors.initials: M
authors.lastname: Viganò
mesh_terms: D000293:Adolescent; D000328:Adult; D003141:Communicable Diseases / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006331:Heart Diseases / Q000209:etiology; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D016041:Heart-Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007558:Italy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult