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J Thorac Cardiovasc Surg 1994;108:1150-1151
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Donor-recipient size match in heart transplantation

Papworth Hospital
Cambridge CB3 8RE, United Kingdom

To the Editor:

Although we entirely agree with the message of Sethi and associates in their article, "Clinical Significance of Weight Difference Between Donor and Recipient in Heart Transplantation" (J THORAC CARDIOVASC SURG 1993;106:444-8), we must disagree with their conclusion: "It would be ideal to use the heart from a donor with exact donor-recipient weight match" We contend that this is unecessary and misleading, because much of the apparent weight of these patients is edema fluid, not true body mass. It has been our policy for a number of years to match potential donors and recipients by height, not by weight.

At our unit, when we are offered both heart and lungs for transplantation, we regularly perform domino operations using the heart from the heart-lung recipient in a heart recipient. The patient population served by the former procedure comprises mainly patients with cystic fibrosis and those with bronchiectasis, who are severely malnourished because of chronic infection. With our standard protocol of matching donors and recipients by height rather than by weight, we are able to use the hearts of these light "donors" in heart recipients who are much heavier.

Since our first domino operation in April 1989, we have performed 38 such procedures totally within our unit. The average weight difference between donor and recipient was 26.3% (range -8.6% to 50.6%), and the average height difference was 2.2% (range -10.6% to 13.1%). The pressure drop across the pulmonary circulation averaged 8.1 mm Hg (range 4 to 13 mm Hg) and the average ischemic time was 2.1 hours (range 39 minutes to 3 hours).

The 30-day mortality rate was 5.3% (2/38), one death from elevated pulmonary vascular resistance on the eighth day and the other death from infection on the twenty-second day. Neither death was considered to be due to primary organ failure. This result compares with our results for patients undergoing nondomino transplant operations over the same period, in whom the 30-day mortality rate was 8.8% (17/194). The total 1-year survival was 79% and the 2-year survival 76.3% for the patients having domino operations. This was not statistically significantly different from the results for our patients having nondomino operations, nor was the mortality weighted toward those patients with a greater weight mismatch.

There was no difference between the groups in terms of duration or dosage of inotropic requirements, nor was there any difference in exercise capacity at long-term follow-up or episodes of infection or rejection.

Our results therefore confirm that the 20% weight discrepancy can safely be exceeded, but we would argue that weight is not a sensitive discriminator. The presence of ascites and edema falsely increases the weight, and therefore it cannot be a good predictor of cardiac workload requirements. Height, however, is a more reliable predictor, and this fact is appreciated in the standard calculation for determining body surface area (S = Wt^0.425 x Ht^0.725 x 71.84), ¹ where height has a greater power (0.725) than weight (0.425).

References

1. Dubois D, Dubois EF. Clinical calorimetry; fifth paper. Measurement of the surface area of man. Arch Intern Med 1915;15:868.
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Andrew Parry Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Parry, A. Articles by Large, S. Search for Related Content PubMed Articles by Parry, A. Articles by Large, S.