Donor–recipient height ratio and outcomes in pediatric heart transplantation

Patel, Anjlee; Bock, M.J.; Wollstein, Adi; Nguyen, Khanh; Malerba, Stefano; Lytrivi, Irene D.

doi:10.1111/petr.12734

Cited by 18 publications

(11 citation statements)

References 13 publications

(20 reference statements)

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“…Height remains an underappreciated measure of size matching that may predict complicated transplants requiring extensive resection for fit. Only one previous study in pediatric heart transplantation analyzed donor‐recipient height ratios, finding that height matching predicts short‐term survival better than weight in pediatric recipients with dilated cardiomyopathy 18 . This is consistent with our finding that taller donors were at especially increased risk of 1‐year mortality, independent of weight mismatch.…”

Section: Discussionsupporting

confidence: 91%

Height mismatch: An overlooked component of adult heart transplant outcomes

Rudasill

Sanaiha

Mardock

et al. 2020

Clinical Transplantation

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Heart transplantation guidelines recommend against matching donors with significant weight but not height discrepancies. This study analyzed the impact of donor‐recipient height mismatch on mortality among heart transplant recipients. We retrospectively analyzed all adult patients in the United Network for Organ Sharing (UNOS) registry undergoing heart transplantation from 1990 to September 2016. Moderate and severe height mismatch were classified as >10% and >15% difference in donor height from recipient height, respectively. The primary outcome was 1‐year mortality. Adjusted Cox hazards regression was performed, and Kaplan‐Meier estimates illustrated 10‐year survival. Of 44 877 transplants, 4822 (10.7%) were moderately height mismatched. Height‐mismatched recipients were more frequently female (41.6% vs 21.8%, P < .001), sex mismatched (53.8% vs 24.9%, P < .001), and weight mismatched (4.9% vs 1.9%, P < .001). After adjustment, recipients of moderately (HR = 1.15 [1.02‐1.30]) and severely (HR = 1.38 [1.10‐1.74]) taller donor hearts were at increased risk of mortality at 1 year relative to height‐matched recipients. Furthermore, of 1042 (21.6%) severe mismatches, recipients with taller (HR = 1.39 [1.11‐1.74]) but not shorter (HR = 0.79 [0.44‐1.43]) donors faced increased 10‐year mortality. The effect was pronounced among re‐transplant candidates (HR = 1.96 [1.07‐3.59]). In conclusion, matching with moderately or severely taller donors is an independent predictor of mortality among primary and re‐transplant candidates.

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Section: Discussionsupporting

confidence: 91%

Height mismatch: An overlooked component of adult heart transplant outcomes

Rudasill

Sanaiha

Mardock

et al. 2020

Clinical Transplantation

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“…They found no effect on post-transplant survival when the donor weight was 60%-80% of the recipient weight but reported lower 30 day survival in infant recipients with donor weight <60% of the recipient weight. In another report, Patel et al analyzed 2133 US children who underwent HT for dilated cardiomyopathy during 1989-2012 (2). DR size mismatch using either weight or height was not associated with post-transplant survival in multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Size match using body measurements is essentially an attempt to match the donor and the recipient for their "normal" or "predicted" heart size to allow adequate mediastinal space for the donor heart and a donor heart that is able to support the recipient circulation after removal of the diseased heart. Previous analyses in pediatric HT recipients using weight or height to assess the effect of DR size match have shown either absent or only a marginal association of DR size-mismatch with recipient survival (1)(2)(3). This may be explained by a cautious selection of donors by pediatric HT community over the years such that a large enough sample of size-mismatched DR pairs to demonstrate an effect on graft outcomes does not exist.…”

Section: Introductionmentioning

confidence: 98%

Matching Donor and Recipient Size in Pediatric Heart Transplantation

Singh

Colan

2022

Transpl Int

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Previous analyses in pediatric heart transplant (HT) recipients using weight or height have not found donor-recipient size-mismatch to be associated with post-transplant mortality. A recent study in 3,215 normal US children developed an equation for left ventricular (LV) mass using body surface area (BSA). We assessed whether donor-recipient size match using predicted LV mass (PLM) is associated with post-transplant in-hospital mortality or 1-year graft survival. We identified 4,717 children <18 yrs old who received primary HT in the US during 01/2000 to 03/2015 and divided them into five groups [10%, 10%, 60% (reference group), 10% and 10%, respectively] with increasing donor-recipient PLM ratio. In adjusted analysis, group 1 children (PLM ratio ≤.90) were at higher risk of post-transplant in-hospital mortality [Odds Ratio (OR) 1.55, 95% CI 1.04, 2.31]. This association of the most undersized donors with recipient in-hospital mortality was similar when donor-recipient weight ratio<.88 or BSA ratio<.92 (lowest decile) were used instead. There was no difference in 1-year graft survival among groups. Utilizing donors with donor-recipient PLM ratio ≤.90 is associated with higher risk of early post-transplant mortality in pediatric HT recipients. However, this metric is not superior to donor-recipient weight ratio or BSA ratio for assessing size match.

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“…Different matching methods of the donor-to-recipient match could be a supplemental option. Prior studies have explored many other indicators, such as height, body mass index (BMI) mismatch, ejection fraction (EF), and predicted heart mass (PHM) mismatch, in order to find a more suitable metric for matching in adult HTx [ 3 , 11 , 12 , 13 , 14 ]. However, pediatric HTx has lagged in this field.…”

Section: Discussionmentioning

confidence: 99%

Donor-Recipient Weight Match in Pediatric Heart Transplantation: Liberalizing Weight Matching with Caution

Chen

et al. 2022

JCDD

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(1) Background: To expand the donor pool, greater donor hearts tended to be used in heart transplantation. However, the data about the feasibility of expanding the donor and recipient weight ratios (DRWRs. All donor and recipient weight ratio (DRWR) in this study or cited from other articles were converted to the DRWR calculated by ((donor weight-recipient weight)/recipient weight) × 100%.) to >30% was still scant in China’s pediatric heart transplantation (HTx). The potential risk increased along with the further expansion of the appropriate range of DRWR to >30% and its upper limit was still in debate. (2) Methods: Seventy-eight pediatric patients (age < 18 years) undergoing HTx between 2015 and 2020 at our center were divided into two groups based on the DRWR (>30% and ≤30%). Variables were summarized and analyzed via univariate analyses and multivariate analyses. A Kaplan-Meier methodology was used to calculate survival and conditional survival. (3) Results: No significant difference was found in one-year, three-year or five-year survival between the two groups. (4) Conclusions: The expansion of DRWR to >30% was acceptable for China’s pediatric HTx. Notably, continuously liberalizing of the upper DRWR boundary to more than 200% could be used as a stop-loss option but should be applied with caution.

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Donor–recipient height ratio and outcomes in pediatric heart transplantation

Cited by 18 publications

References 13 publications

Height mismatch: An overlooked component of adult heart transplant outcomes

Height mismatch: An overlooked component of adult heart transplant outcomes

Matching Donor and Recipient Size in Pediatric Heart Transplantation

Donor-Recipient Weight Match in Pediatric Heart Transplantation: Liberalizing Weight Matching with Caution

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