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CASE ANECDOTES, COMMENTS AND OPINIONS Heart donation and the Grinch effect Robert M. Reed, MD,a and Michael Eberlein, MD, PhDb From the aDivision of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and the b Division of Pulmonary and Critical Care Medicine, University of Iowa School of Medicine, Iowa City, Iowa
It was with great interest that we read the recent article by Kransdorf and Stehlik.1 We commend the authors on their work and agree that optimization of the organ matching process with a more comprehensive incorporation of factors shown to influence outcomes would improve cardiac allocation. We have previously suggested that the size difference between donor and recipient hearts is such a factor. We showed that the donor—recipient weight differences that are currently used to limit organ allocation fail to predict outcomes. Consideration of differences in predicted cardiac mass, however, demonstrated worse survival associated with undersizing.2 We coined this the
Reply: Heart donation and the Grinch effect Evan P. Kransdorf, MD, PhD,a and Josef Stehlik, MD, MPHb From the aDivision of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona; and the bDivision of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
We thank Reed and Eberlein for their comments. We agree that donor-recipient size matching is an important issue in thoracic transplantation, and that matching by estimated cardiac mass, rather than by weight and height, may better correlate with post-transplant outcomes. We suspect there are
“Grinch effect,” in recognition of the Dr. Seuss character whose heart was “two sizes too small.” These findings echo our earlier work in lung transplantation,3 and we suggest that improvements in size matching could result in tangible improvements in outcomes after thoracic organ transplant.
Disclosure statement The authors have no conflicts of interest to disclose. R.M.R. is funded in part by the Flight Attendant Medical Research Institute.
References 1. Kransdorf EP, Stehlik J. Donor evaluation in heart transplantation: the end of the beginning. J Heart Lung Transplant 2014;33:1105-13. 2. Reed RM, Netzer G, Hunsicker L, et al. Cardiac size and sex-matching in heart transplantation: size matters in matters of sex and the heart. J Am Coll Cardiol Heart Fail 2014;2:73-83. 3. Eberlein M, Reed RM, Bolukbas S, et al. Lung size mismatch and survival after single and bilateral lung transplantation. Ann Thorac Surg 2013;96:457-63.
additional interactions between donor-recipient cardiac mass match, other donor and recipient characteristics, and outcome—just as is the case for donor-recipient weight match.1 This illustrates the complexity we face as we try to accurately estimate the risk attributable to individual donor characteristics at the time of organ allocation to transplant candidates.
Disclosure statement The authors have no conflicts of interest to disclose.
Reference 1. Stehlik J, Feldman DS, Brown RN, et al. Interactions among donor characteristics influence post-transplant survival: a multi-institutional analysis. J Heart Lung Transplant 2010;29:291-8.
1053-2498/$ - see front matter 2015 International Society for Heartand Lung Transplantation. All rights reserved. http://dx.doi.org/10.1016/j.healun.2014.07.004
CASE ANECDOTES, COMMENTS AND OPINIONS Heart donation and the Grinch effect Robert M. Reed, MD,a and Michael Eberlein, MD, PhDb From the aDivision of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and the b Division of Pulmonary and Critical Care Medicine, University of Iowa School of Medicine, Iowa City, Iowa
It was with great interest that we read the recent article by Kransdorf and Stehlik.1 We commend the authors on their work and agree that optimization of the organ matching process with a more comprehensive incorporation of factors shown to influence outcomes would improve cardiac allocation. We have previously suggested that the size difference between donor and recipient hearts is such a factor. We showed that the donor—recipient weight differences that are currently used to limit organ allocation fail to predict outcomes. Consideration of differences in predicted cardiac mass, however, demonstrated worse survival associated with undersizing.2 We coined this the
Reply: Heart donation and the Grinch effect Evan P. Kransdorf, MD, PhD,a and Josef Stehlik, MD, MPHb From the aDivision of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona; and the bDivision of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
We thank Reed and Eberlein for their comments. We agree that donor-recipient size matching is an important issue in thoracic transplantation, and that matching by estimated cardiac mass, rather than by weight and height, may better correlate with post-transplant outcomes. We suspect there are
“Grinch effect,” in recognition of the Dr. Seuss character whose heart was “two sizes too small.” These findings echo our earlier work in lung transplantation,3 and we suggest that improvements in size matching could result in tangible improvements in outcomes after thoracic organ transplant.
Disclosure statement The authors have no conflicts of interest to disclose. R.M.R. is funded in part by the Flight Attendant Medical Research Institute.
References 1. Kransdorf EP, Stehlik J. Donor evaluation in heart transplantation: the end of the beginning. J Heart Lung Transplant 2014;33:1105-13. 2. Reed RM, Netzer G, Hunsicker L, et al. Cardiac size and sex-matching in heart transplantation: size matters in matters of sex and the heart. J Am Coll Cardiol Heart Fail 2014;2:73-83. 3. Eberlein M, Reed RM, Bolukbas S, et al. Lung size mismatch and survival after single and bilateral lung transplantation. Ann Thorac Surg 2013;96:457-63.
additional interactions between donor-recipient cardiac mass match, other donor and recipient characteristics, and outcome—just as is the case for donor-recipient weight match.1 This illustrates the complexity we face as we try to accurately estimate the risk attributable to individual donor characteristics at the time of organ allocation to transplant candidates.
Disclosure statement The authors have no conflicts of interest to disclose.
Reference 1. Stehlik J, Feldman DS, Brown RN, et al. Interactions among donor characteristics influence post-transplant survival: a multi-institutional analysis. J Heart Lung Transplant 2010;29:291-8.
1053-2498/$ - see front matter 2015 International Society for Heartand Lung Transplantation. All rights reserved. http://dx.doi.org/10.1016/j.healun.2014.07.004
