Impact of donor-to-recipient weight ratio on the hospital outcomes of pediatric heart transplantation

Abstract

Background Identifying the factors that can influence the prognosis and final outcomes of pediatric heart transplantation is important and makes it possible to prevent complications and improve outcomes. Coordination of donor characteristics with the recipient in terms of sex, weight, body mass index (BMI), and body surface area (BSA) is an important factor that can influence the outcome of the transplantation. There is still no consensus regarding the role of discrepancy in anthropometrics between donors and recipients. The aim of this study was to investigate the relationship between donor and recipient weight mismatch on the early outcomes of pediatric heart transplantation. In this historical cohort study, 80 children who had underwent heart transplantation for the first time between 2014 and 2019 in Shahid Rajaie Cardiovascular Medical and Research Center in Tehran, Iran, were enrolled and divided into three groups according to donor-to-recipient weight ratio (0.8 < D/RW ≤ 1.5, 1.5 < D/RW ≤ 2.5, and 2.5 < D/RW). The early outcomes of transplantation, during the first post-transplant month, including right heart failure, renal failure, graft rejection, inotrope dependency, duration of intubation, length of ICU stay, death and requiring extracorporeal membrane oxygenation, were recorded through reviewing patient records. Results Median donor-to-recipient BSA ratio was directly associated with higher vasoactive–inotropic score (P = 0.038), while no significant association was found between donor-to-recipient weight ratio and vasoactive–inotropic score (P = 0.07). No significant relationship was found between other outcomes and donor-to-recipient weight ratio or donor-to-recipient BSA ratio. Conclusions Patients who require heart transplantation may also benefit from mismatch donors, especially in those with significant cardiomegaly.

Female donor hearts can improve survival for male pediatric heart transplant recipients

“…Although many, including the authors' group, have advocated for the widespread implementation of improved and more precise measurements to ensure optimal size‐matching between recipient and donor, but the most commonly utilized method remains the DRWR 14,19,23–25 . The lower limit of DRWR acceptability is typically cited as a ratio of 0.8, with “oversizing” commonly defined as >1.5 1,7,9,10,21 . Consistent with prior studies, the present analysis also found that undersizing (DRWR < 0.8) was associated with inferior survival compared with ideal‐ or oversized DRWR—but only among male recipients, not female.…”

“…Additionally, patients were grouped by DRWR into three groups. DRWR cutoffs were based upon those widely used in the literature and the accepted standards for undersized (<0.8) and oversized (>1.5) pairings 1,7,9,10 . DRWR groups included: <0.8 (undersized), 0.8–1.5 (ideal‐sized), and >1.5 (oversized).…”

“…DRWR cutoffs were based upon those widely used in the literature and the accepted standards for undersized (<0.8) and oversized (>1.5) pairings. 1,7,9,10 DRWR groups included: <0.8 (undersized), 0.8-1.5 (ideal-sized), and >1.5 (oversized). Patients were categorized into one of the 12 corresponding gender-and weight-paired groups ( those factors found to be significant (p < .1) upon univariable analysis (Table S1).…”

Paediatric heart transplantation during the COVID‐19 pandemic in Iran: single‐centre experience

“…In addition, most of the hearts donated for paediatric patients in Iran are from adults who experienced multiple traumas and falls and suffered from intracranial haemorrhage, causing a difference in weight and age between the donor and the recipient. A prior investigation of our group showed that heart transplants from donors that are not matched in weight with the recipient, especially if the donor's heart is larger, can be utilized for paediatric heart transplant candidates without any noticeable impact on the outcome compared with weight‐matched donors 7 . In addition, previous studies from other centres that have analysed the impact of donor‐recipient size mismatch on paediatric heart transplant recipients by using weight or height as measures have found either no significant association or only a slight relationship between donor‐recipient size mismatch and the survival of the recipient 8,9 …”

“…Throughout the pandemic period considering the unknown nature of the virus and complications in both immune‐competent and immunocompromised patients, the changes in paediatric transplant services occurred during a different phase of the pandemic. Safe management of waitlisted and immunodeficient recipient patients was essential, and paediatric transplant centres worldwide have followed different strategies following international recommendations to address this problem 6,7 …”