Heart Failure
Donor LV Geometric Remodeling and Hypertrophy — Impact on Acceptance and Recipient Survival
- Authors: Donor Heart Study investigators
- Journal / date: JACC: Heart Failure, May 2026 (Vol 14, No 5)
- DOI / URL: 10.1016/j.jchf.2026.103150 | PMID 42159513
- Source basis: Full text (JACC login)
- Study type: Multicenter donor heart study, retrospective
- Population: 3,647 brain-dead donors (Feb 2015 – May 2020) across US transplant centers
- Exposure: LV geometric remodeling patterns per ASE guidelines vs current threshold of LV wall thickness >1.3 cm
- Key findings:
- Concentric remodeling was the most common pattern (58.5%) of brain-dead donor LV geometry
- Donors with wall thickness >1.3 cm were more often reclassified as concentric remodeling (52.1%) than concentric hypertrophy (43.8%)
- 20.3% of declined donors had LVH listed as the rejection reason — but most had normal geometry (10.8%) or concentric remodeling (60.0%), not true hypertrophy
- Neither wall thickness >1.3 cm (aHR 0.94, 0.73-1.21), concentric remodeling (aHR 1.13), nor concentric hypertrophy (aHR 0.64) was associated with 3-year recipient mortality
- Why it matters (clinical takeaway):
- Using geometric remodeling pattern rather than wall thickness alone could expand the acceptable donor pool without compromising recipient survival.
- Practically: when reviewing offered donor echos, document the remodeling pattern (geometry + wall thickness) rather than rejecting on isolated wall thickness >1.3 cm.
- Supports updating donor screening guidelines to incorporate ASE remodeling classification.
- Caveats / limitations: Retrospective observational; selection bias for accepted hearts; 3-year survival may not capture all relevant outcomes.
- Referenced trials pulled forward: None this pass.