EXCELLENT OUTCOME OF CARDIAC TRANSPLANTATION USING DOMINO-DONOR HEARTS

Objective. Domino cardiac transplantation affords flexible and optimal organ utilization, provides hearts unaffected by brain death, allows prospective tissue matching, and subsequent transplantation with short allograft ischemic times, A retrospective review of our experience wi th domino cardiac transplantation has been made. Methods. Seventy-two of 119 patients who underwent heart-lung transplantation from 1988 on served as domino cardiac donors (40 males, 32 females: mean age of 32, years; mean weight of 51 kg). The domino donor diagnoses were cystic fibrosis (n = 47), bronchiectasis (n = 9), primary pulmonary hypertens ion (n = 6), emphysema (n = 7), pulmonary fibrosis (n = 2) and Eisenme nger's syndrome (n = 1). Forty-seven domino hearts were transplanted a t our institution and 25 were exported to other centres in the United Kingdom. The 72 domino cardiac recipients were 62 miles and 10 females , mean age of 47 years, mean weight of 60 kg, with ischemic heart dise ase (n = 32), cardiomyopathy (n = 36) and other conditions (n = 4). Re sults. There were four deaths (5.6%) at less than 30 days (2 from mult iple organ failure, 1 from primary allograft failure and 1 from acute rejection). Actuarial survival estimates and 1 and 5 years were 77 +/- 5.2% nd 69 +/- 6.3%, respectively. This compared favourably with surv ival data obtained in 234 non-domino cardiac recipients. In the patien ts transplanted at Papworth, there was no difference in the incidence of rejection (0.6 +/- 0.05 versus 0.7 +/- 0.03 events per 100 patient days for the first 12 months) or in the freedom from graft atheroscler osis (74 +/- 3% versus 70 +/- 3% at 5 years) between the domino and no n-domino groups. Conclusions. The use of domino hearts donated by reci pients of heart-lung transplants is beneficial and is associated with an excellent early and longer-term outcome.