HETEROTOPIC HEART TRANSPLANTATION: POTENTIAL FOR INCREASING DONOR UTILISATION
J.A. Webb*, M. Richardson, P.J. Bergin, D.M. Kaye, D.S. Esmore.
Heart and Lung Transplant Service, The Alfred Hospital, Melbourne, Victoria.
Background: Despite the success of orthotopic heart transplantation (OHTx), donor shortage, increasing waiting list time (particularly for larger recipients) and inability to offer OHTx to patients (pts) with pulmonary hypertension remain significant problems.
Methods: From August 1997 to February 1999, 41 transplants were performed at our institution. Seven (17%) of these, all males, mean age 56.7 years, were heterotopic heart transplants (HHTx). The indications for HHTx were pulmonary hypertension in all pts (mean PA ± SEM = 42 ± 3.8mmHg) and in 4 cases, significant recipient-donor weight mismatch.
Results: Mean donor-recipient weight ratio for HHTx was 0.71 (range 0.55-0.88) and for OHTx over the same period was 1.02 (p<0.002). Five donors used for HHTx weighed < 65kgs and were unsuitable for recipients awaiting OHTx. At 4.5 months mean follow-up (range 0.25-8.0 months) 6 of 7 are alive, with 5 out of 6 in NYHA functional class 1 and 1 pt in class 2. One recipient died at day 7 from intrathoracic haemorrhage.
Patient Demographics and Complications:
|
Pt No. |
R Wt : D Wt (Kilograms) |
Waiting List (days) |
ICU Stay (days) |
Treated Rejection Episodes |
Infection Episodes |
Other Complications |
|
1 |
90:50 |
2 |
0 |
0 |
Intrathoracic Haem. |
|
|
2 |
81:60 |
8 |
0 |
3 |
VT/IABP/graft failure |
|
|
3 |
87:56 |
23 |
1 |
1 |
ATN/myopathy/HF |
|
|
4 |
79:70 |
40 |
10 |
0 |
1 |
IABP/ATN/stroke |
|
5 |
70:42 |
30 |
38 |
0 |
0 |
Stroke/fit/AF |
|
6 |
96:83 |
10 |
1 |
0 |
ATN |
|
|
7 |
90:62 |
1 |
0 |
0 |
Figure Legend: VT = Ventricular Tachycardia (native heart), IABP = Intra-aortic Balloon Pump, ATN = Acute Tubular Necrosis, AF = Atrial Fibrillation, HF = Heart Failure, R Wt = Recipient weight, D Wt = Donor weight.
Conclusion: HHTx is a successful adjunctive therapy for heart failure. It allows expansion of the donor pool, potential reduction in waiting time and is an alternative for those unsuitable for OHTx. Despite significant early management difficulties, intermediate term results are promising.
