title: Selecting oversized donor cardiac allografts for patients with pulmonary hypertension may be unnecessary.
abstract: BACKGROUND
  There is a tendency to favor oversized donor hearts for heart transplant candidates affected by mild to moderate pulmonary hypertension (PHTN). We hypothesize that both undersized and oversized donor hearts fare equally well in this setting.
  
  
  METHODS
  A total of 107 cases from 2003 to 2008 were retrospectively reviewed and subsequently divided into those receiving organs from undersized donors (group 1: donor weight/recipient weight ≤ 0.90, n = 37) and oversized donors (group 2: donor weight/recipient weight ≥ 1.2, n = 70). PHTN was identified in the perioperative period in those patients with systolic pulmonary artery pressure (SPAP) ≥ 40 mm Hg. Endpoints of mortality and hemodynamic data were investigated.
  
  
  RESULTS
  Of 107 patients, 37 received undersized donor allografts, with a mean donor-to-recipient weight ratio of 0.8, and 70 received oversized donors allografts, with a mean donor-to-recipient ratio of 1.4. Perioperative PAH was diagnosed in 20 of the 37 (54%) patients from the undersized group (mean SPAP = 45.9 mm Hg) and 41 of 70 (59%) patients from the oversized group (mean SPAP = 46.5 mm Hg). There was no significant difference in right ventricular function at 1 week, 1 month, or 6 months. Left ventricular function was similar between both groups at 6 months (P = .22). The mean SPAP in the undersized group was 45.9, 33.4, 31.8, and 23.1 mm Hg at the perioperative, 1 week, 1 month, and 6 month time points, respectively. Corresponding mean SPAP for the oversized group was 46.5, 35.0, 29.4, and 26.1 mm Hg. The 1 month, 1 year, and 3 year survivals were similar in both groups.
  
  
  CONCLUSIONS
  Oversized and undersized donor hearts fared equally well in the setting of mild to moderate perioperative PAH. This in addition to the propensity for resolution of pulmonary hypertension over time suggests that the current practice of favoring oversized donor hearts for patients with pre-transplantation PAH may be unwarranted.
authors.affiliation: Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. Electronic address: mkwon@mednet.ucla.edu.
authors.forename: M H
authors.initials: MH
authors.lastname: Kwon
authors.affiliation: Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: S
authors.initials: S
authors.lastname: Wong
authors.affiliation: Cedars Sinai Heart Institute, Los Angeles, California, USA.
authors.forename: M
authors.initials: M
authors.lastname: Kittleson
authors.affiliation: Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ardehali
authors.affiliation: Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: H
authors.initials: H
authors.lastname: Laks
authors.affiliation: Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Shemin
authors.affiliation: Cedars Sinai Heart Institute, Los Angeles, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kobashigawa
mesh_terms: D005260:Female; D016027:Heart Transplantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome