Predicted heart mass is the optimal metric for size match in heart transplantation

Kransdorf, E.; Kittleson, M.; Benck, Lillian; Patel, J.; Chung, Joshua; Esmailian, F.; Kearney, B.; Chang, D.; Ramzy, Danny; Czer, L.; Kobashigawa, Jon A.

doi:10.1016/j.healun.2018.09.017

Cited by 139 publications

(123 citation statements)

References 20 publications

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“…Donor data was obtained from Donornet/UNOS. Donor‐recipient predicted heart mass (PHM) was calculated according to previously described equations for size match in heart transplantation from Kransdorf et al…”

Section: Methodsmentioning

confidence: 99%

Discontinuing amiodarone treatment prior to heart transplantation lowers incidence of severe primary graft dysfunction

Hoemann

Takayama

Jennings

et al. 2020

Clinical Transplantation

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Background Recent studies have shown an increased incidence of primary graft dysfunction (PGD) in patients treated with amiodarone prior to orthotopic heart transplant (OHT). We hypothesized that discontinuation of amiodarone before OHT may lower the incidence of severe PGD. Methods This was a single‐center retrospective study of 381 adult OHT recipients between January 2010 and June 2017. Within 6 months prior to OHT, 197 did not receive amiodarone (Group 1), 142 continued amiodarone to OHT (Group 2), and 42 had amiodarone treatment discontinued before OHT (Group 3). Results 53 (13.9%) participants developed severe PGD, 13 (6.6%) of which were in Group 1, 36 (25.4%) were in Group 2, and 4 (9.5%) were in Group 3 (P < .001). Multivariable analysis revealed continued amiodarone treatment to OHT (Group 2; OR, 3.70; 95% CI, 1.26‐10.88; P = .018) to be an independent risk factor for the development of severe PGD when Group 1 served as the reference group. Moreover, patients in Group 3 had no difference in the risk of severe PGD (OR = 0.416, 95% CI = 0.08‐2.15; P = .296). Conclusion We found that discontinuing amiodarone treatment prior to OHT resulted a lower incidence of severe PGD.

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Section: Methodsmentioning

confidence: 99%

Discontinuing amiodarone treatment prior to heart transplantation lowers incidence of severe primary graft dysfunction

Hoemann

Takayama

Jennings

et al. 2020

Clinical Transplantation

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“…3,5 This finding was recently confirmed in a UNOS registry analysis consisting of 19,168 transplant recipients between 2007 and 2016. 10 Patients with PHM < 0.86 had increased 1year-mortality (HR, 1.34; 95% confidence interval: 1.13, 1.59; p < 0.001). However, similar to our analysis, conventional measures of donor and recipient matching, such as body weight, height, BMI, and BSA, did not predict mortality.…”

Section: Discussionmentioning

confidence: 93%

“…Thus, even in our undersized group adequate heart mass has been assured consistent with the recently defined PHM value of >0.86. 10 In addition, it has previously been hypothesized that undersized hearts can increase myocardial mass over time to adapting to the new hemodynamic environment. 8,10,22 These results demonstrate that using body size measures alone are insufficient for optimal organ matching.…”

Section: Discussionmentioning

confidence: 99%

“…PHM was calculated as previously described. 10 PHM = predicted right ventricular mass + predicted left ventricular mass. Predicted right ventricular mass = a × age −0.32 × height 1.135 × weight 0.315 (a = 10.59 for females and 11.25 for males).…”

Section: Study Groupsmentioning

confidence: 99%

“…Furthermore, predicted heart mass (PHM) had been recently introduced as a matching method, and a D/R ratio of ≥0.86 has been identified as a cut off enabling safe transplantation in hearts graded as undersized per body weight matching algorithms. 10…”

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confidence: 99%

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Increasing heart transplant donor pool by liberalization of size matching

Holzhauser

Imamura

Bassi

et al. 2019

The Journal of Heart and Lung Transplantation

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BACKGROUND-The heart transplant (HT) guidelines recommendation to match recipient and donors within 30% of body weight lacks a strong evidence base and is not well established in patients bridged to transplant with left ventricular assist devices (LVAD). In light of the scarcity of donor hearts, we investigated the effect of size mismatch on hemodynamics, one-year survival and length of stay (LOS) following HT. METHODS-Single-center retrospective analysis of consecutive HT patients from April 2007 to September 2017. Recipients were divided into 3 cohorts based on donor-to-recipient weight ratio (DRWR): (1) undersized (<0.7), (2) size-matched, (0.7-1.3); (3) oversized (>1.3). RESULTS-288 consecutive patients were identified (mean age 53 ± 11 years; 76% male), 46 were undersized (0.61 ± 0.05), 210 size-matched (0.94 ± 0.16), and 32 oversized (1.65 ± 0.38). There was no significant difference in donor left ventricular end diastolic diameter (LVEDD) between the 3 groups (p = 0.11). The donor/recipient (D/R) predicted heart mass (PHM) was lowest in the undersized group (0.92 ± 0.13). There were no significant differences in 1-year survival in the overall and LVAD cohort (p = 0.65 and 0.59, respectively). Neither donor LVEDD nor D/R PHM differed among survivors or non-survivors. LOS was longer in the undersized group than the size-matched cohort (p = 0.004). The undersized group had hearts with the highest filling pressures and lowest cardiac index at 1 week among the remaining groups (p = 0.009, 0.017, and p = 0.05, respectively). There were no clinically significant differences in hemodynamics at 1 or 6 months.

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Association of Size Matching Using Predicted Heart Mass With Mortality in Heart Transplant Recipients With Obesity or High Pulmonary Vascular Resistance

et al. 2023

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ImportancePretransplant obesity and higher pulmonary vascular resistance (PVR) are risk factors for death after heart transplant. However, it remains unclear whether appropriate donor-to-recipient size matching using predicted heart mass (PHM) is associated with lower risk.ObjectiveTo investigate the association of size matching using PHM with risk of death posttransplant among patients with obesity and/or higher PVR.Design, Setting, and ParticipantsAll adult patients (&gt;18 years) who underwent heart transplant between 2003 and 2022 with available information using the United Network for Organ Sharing cohort database. Multivariable Cox models and multivariable-adjusted spline curves were used to examine the risk of death posttransplant with PHM matching. Data were analyzed from October 2022 to March 2023.ExposureRecipient’s body mass index (BMI) in categories (&lt;18.0 [underweight], 18.1-24.9 [normal weight, reference], 25.0-29.9 [overweight], 30.0-34.9 [obese 1], 35-39.9 [obese 2], and ≥40.0 [obese 3]) and recipient’s pretransplant PVR in categories of less than 4 (29 061 participants), 4 to 6 (2842 participants), and more than 6 Wood units (968 participants); and less than 3 (24 950 participants), 3 to 5 (6115 participants), and 5 or more (1806 participants) Wood units.Main OutcomeAll-cause death posttransplant on follow-up.ResultsThe mean (SD) age of the cohort of 37 712 was 52.8 (12.8) years, 27 976 (74%) were male, 25 342 were non-Hispanic White (68.0%), 7664 were Black (20.4%), and 3139 were Hispanic or Latino (8.5%). A total of 12 413 recipients (32.9%) had a normal BMI, 13 849 (36.7%) had overweight, and 10 814 (28.7%) had obesity. On follow-up (median [IQR] 5.05 [0-19.4] years), 12 785 recipients (3046 female) died. For patients with normal weight, overweight, or obese 2, receiving a PHM-undermatched heart was associated with an increased risk of death (normal weight hazard ratio [HR], 1.20; 95% CI, 1.07-1.34; overweight HR, 1.12; 95% CI, 1.02-1.23; and obese 2 HR, 1.07; 95% CI, 1.01-1.14). Moreover, patients with higher pretransplant PVR who received an undermatched heart had a higher risk of death posttransplant in multivariable-adjusted spline curves in graded fashion until appropriately matched. In contrast, risk of death among patients receiving a PHM-overmatched heart did not differ from the appropriately matched group, including in recipients with an elevated pretransplant PVR.Conclusion and RelevanceIn this cohort study, undermatching donor-to-recipient size according to PHM was associated with higher posttransplant mortality, specifically in patients with normal weight, overweight, or class II obesity and in patients with elevated pretransplant PVR. Overmatching donor-to-recipient size was not associated with posttransplant survival.

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Predicted heart mass is the optimal metric for size match in heart transplantation

Cited by 139 publications

References 20 publications

Discontinuing amiodarone treatment prior to heart transplantation lowers incidence of severe primary graft dysfunction

Discontinuing amiodarone treatment prior to heart transplantation lowers incidence of severe primary graft dysfunction

Increasing heart transplant donor pool by liberalization of size matching

Association of Size Matching Using Predicted Heart Mass With Mortality in Heart Transplant Recipients With Obesity or High Pulmonary Vascular Resistance

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