Lh. Blackbourne et al., SUCCESSFUL USE OF UNDERSIZED DONORS FOR ORTHOTOPIC HEART-TRANSPLANTATION - WITH A CAVEAT, The Annals of thoracic surgery, 57(6), 1994, pp. 1472-1476
Accepted clinical practice has been to require body weights to be with
in 20% as a criterion for matching donor to recipient for cardiac tran
splantation. From November 1989 through September 1993 we began accept
ing larger differences in body weight between donor and recipient with
80 orthotopic heart transplants performed. Twenty-eight of these tran
splants used undersized donors (donor-to-recipient body weight ratio [
DRBW] of 0.6 to 0.8) with the remaining donors being either size match
ed (DRBW = 0.8 to 1.0) or oversized (DRBW > 1.0). Thirty-three of the
80 transplant recipients (41%) were classified preoperatively as Unite
d Network for Organ Sharing (UNOS) status I and the remaining patients
were classified as UNOS status II. Hospital survival for status I rec
ipients was 9 of 14 (64%) for undersized donors, 7 of 8 (87.5%) for si
zed-matched donors, and 11 of 11 (100%) for oversized donors (p < 0.05
). Hospital survival for status II recipients was 12 of 14 (85.7%) for
undersized donors, 24 of 24 (100%) for sized-matched donors, and 8 of
9 (88.8%) for oversized donors. Our data support the continued use of
hearts from undersized donors in status II recipients. The use of hea
rts from undersized donors in status I recipients is associated with i
ncreased mortality compared with size-matched donors and must be under
taken with caution.