New Thinking On Heart Transplants After Univ. Of Iowa Research - News and Weather For The Quad Cities -

New Thinking On Heart Transplants After University Of Iowa Research


Researchers at the University of Iowa and University of Maryland have found that the manner in which heart donors and recipients are currently matched isn't necessarily creating the best outcome for those transplant patients. That's according to a news release from the University of Iowa.

In a study published online in JACC: Heart Failure by the American College of Cardiology, Dr. Michael Eberlein, assistant professor of internal medicine at UI College of Medicine, and Dr. Robert Reed, assistant professor of medicine at the University of Maryland School of Medicine, contend that matching donors and recipients instead by heart size could provide better outcomes for recipients.

The analysis of 22 years of adult heart transplant data in the U.S. critically reappraises the current practice of matching donors and recipients by body weight rather than heart size. While two people may weigh the same, their hearts could have vastly different sizes - often requiring a smaller donor heart to strain to do the necessary work. The researchers dubbed this the "Grinch" effect, referring to the Dr. Seuss character whose heart was "two sizes too small."

The contrast is especially amplified when a match based on body weight doesn't factor in sex differences. "Men who receive women's hearts are 32 percent more likely to die in the first year after transplantation, and this is entirely because of suboptimal sizing," says the study's principal author, Robert M. Reed, M.D., assistant professor of medicine at the University of Maryland School of Medicine and a transplant pulmonologist at the University of Maryland Medical Center. "Even if the weights of donor and recipient are similar, the female heart is considerably smaller, while women are more often given men's hearts that are larger."

According to study co-author Keshava Rajagopal, M.D., Ph.D., a University of Maryland heart and lung transplant surgeon, the research emphasizes the peril of undersizing. "Undersizing a donor heart is very dangerous. It's like putting a motorcycle engine into a truck," says Rajagopal, assistant professor of surgery at the University of Maryland School of Medicine. "We need to figure out a better way to reliably ascertain heart size to best match donor and recipient." Transplant centers typically limit the pool of acceptable heart donors to those whose body weight is within 30 percent of the recipient's body weight. "This research shows that the current system allows some less-than-optimal matches to occur, while simultaneously reducing access to an already very limited resource for people waiting for heart transplants," Reed says. He and his team propose a new strategy to determine compatibility based on the predicted total heart mass for recipient and donor pairs.

The research conclusions are based on a retrospective analysis of more than 31,000 donor-recipient adult heart transplant pairings from the United Network for Organ Sharing (UNOS) transplant registry between October 1989 and June 2011.

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