• J. Thorac. Cardiovasc. Surg. · Dec 2023

    Is the practice of using oversized organs for recipients with elevated pulmonary vascular resistance justified?

    • Karthik Thangappan, Farhan Zafar, Hosam F Ahmed, Jason W Greenberg, Awais Ashfaq, Russel Hirsch, Clifford Chin, David Lehenbauer, Alan O'Donnell, and MoralesDavid L SDLSDepartment of Cardiovascular Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: David.Morales@cchmc.org..
    • Department of Cardiovascular Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
    • J. Thorac. Cardiovasc. Surg. 2023 Dec 1; 166 (6): 176617791766-1779.

    ObjectiveThe purpose of this study was to assess post-transplantation outcomes in recipients with increased pulmonary vascular resistance (PVR) in relation to donor size.MethodsThe United Network for Organ Sharing database was used to identify patients ages 0 to 18 years at time of listing who underwent transplantation from 2010 to 2019 and for whom cardiac catheterization and donor-recipient weight ratio data were available. Patients were divided according to listing PVR into <3, 3 to 6, and >6 Wood units. Donor-recipient weight ratio was categorized as undersized (≤0.80), midsize (0.81-1.2), and oversized (>1.2). Subgroup analysis was done with an additional supersized group (>2.0).ResultsFourteen hundred ninety-one patients met study criteria. Median age was 10 (interquartile range, 3-15) years and 45% were female. Four percent of heart transplantation cases used undersized, 45% used midsize, and 51% used oversized organs. More patients with PVR >6 were received an oversized organ transplant compared with patients with PVR <3; 59% (148/252) versus 48% (430/894); P = .003. There was no difference in survival among organ size groups regardless of PVR; this includes patients with PVR >6 at listing who received an oversized organ transplant versus an undersized (P = .359) or midsized (P = .956) organ. In subgroup analysis, even in patients who received a supersized organ transplant, there was no survival difference noted regardless of PVR.ConclusionsDespite a persistent practice pattern to transplant oversized organs in high-PVR patients, there remains no difference in post-transplantation survival among these patients and those who received smaller organ transplants. Therefore, transplants in patients with high PVR should not be delayed by waiting for larger donors.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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