Right Ventricular Mass Oversizing is Associated with Improved Post-transplant Survival in Heart Transplant Recipients with Elevated Transpulmonary Gradient

Yeahwa Hong; Nicholas R Hess; Luke A Ziegler; Ander Dorken-Gallastegi; Nidhi Iyanna; Mohamed Abdullah; Edward T Horn; Michael A Mathier; Mary E Keebler; Gavin W Hickey; David J Kaczorowski

doi:10.1016/j.cardfail.2024.09.018

Right Ventricular Mass Oversizing is Associated with Improved Post-transplant Survival in Heart Transplant Recipients with Elevated Transpulmonary Gradient

J Card Fail. 2024 Oct 28:S1071-9164(24)00888-1. doi: 10.1016/j.cardfail.2024.09.018. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, PA, USA; Department of Cardiothoracic Surgery, PA, USA.
² Department of Cardiothoracic Surgery, PA, USA.
³ Department of Surgery, PA, USA.
⁴ Department of Pharmacy and Therapeutics, PA, USA.
⁵ Division of Cardiology at the University of Pittsburgh Medical Center Pittsburgh, PA, USA.
⁶ Department of Cardiothoracic Surgery, PA, USA. Electronic address: kaczorowskidj2@upmc.edu.

PMID: 39477205
DOI: 10.1016/j.cardfail.2024.09.018

Abstract

Background: This study evaluates the effects of pre-transplant transpulmonary gradient (TPG) and donor right ventricular mass (RVM) on outcomes following heart transplantation.

Methods: UNOS registry was queried to analyze adult recipients who underwent primary isolated heart transplantation from 1/1/2010 to 12/31/2018. The recipients were dichotomized into two groups based on their TPG at the time of transplantation, <12 and ≥12 mmHg. The outcomes included 5-year survival and post-transplant complications. Propensity score-matching was performed. Sub-analysis was performed to evaluate the effects of donor-recipient RVM matching, where a ratio <0.85 was classified as undersized, 0.85-1.15 as size-matched, and >1.15 as oversized. RESULTS;: 17,898 isolated heart transplant recipients were analyzed, and 5,129 (28.7%) recipients had TPG ≥12 mmHg at the time of transplantation. The recipients with TPG ≥12 mmHg experienced significantly lower 5-year survival (78.4% vs 81.2%, p<0.001) compared to the recipients with TPG <12 mmHg, and this finding persisted in the propensity score-matched comparison. The recipients with TPG ≥12 mmHg experienced a higher rate of post-transplant dialysis and a longer duration of hospitalization. Oversizing the donor RVM considerably improved the 5-year survival among the recipients with TPG ≥12 mmHg, comparable to those with TPG <12 mmHg.

Conclusion: Elevated pre-transplant TPG negatively impacts post-transplant survival. However, oversizing the donor RVM is associated with improved survival in recipients with elevated TPG, resulting in improved survival that is comparable to recipients with normal TPG. Therefore, careful risk stratification and donor matching among recipients with elevated TPG is essential to improve outcomes in this vulnerable population.

Keywords: Orthotopic heart transplantation; predicted heart mass; right ventricle; transpulmonary gradient.