Donor-Recipient Size Matching in Pediatric Heart Transplantation: Is Weight the Most Appropriate Parameter To Predict Outcomes in All Age Groups?

Abstract

Purpose The aim of this study is to retrospectively review our practice of donor-recipient (D/R) size matching by weight criteria alone and simultaneously reassess and compare post-transplant outcomes using the additional variables of height and body-surface area (BSA). Methods and Materials We retrospectively reviewed the medical records of 211 patients who underwent orthotopic heart transplantation at Boston Children’s Hospital over the past 20 years. The patients were divided into the following age groups: 12 years (n=74). Donor/recipient weight, height and BSA ratios were determined for each age group at the date of transplantation. Outliers were identified for each variable and analyzed separately. We compared the average and median of continuous outcomes such as length of stays, need for open chest, post-transplant filling pressures and survival. Results In our cohort the median D/R weight ratio was 1.276 (0.2-5.0), BSA ratio 1.172 (0.2-2.0) and height ratio1.061 (0.3-2.0). There was no difference in post-transplant survival when comparing outcomes by weight, BSA or height ratios. Increased D/R size ratio was associated with significantly increased likelihood of delayed chest closure, ICU and total hospital length of stay in all ages. The odds ratio was highest for the youngest age group with disproportionate number of outliers (33.3 %) but this effect was less significant when D/R matching was done by BSA. The younger patients were more likely to receive a size-mismatched hearts than older recipients. Conclusions The current practice of using weight for donor-recipient size matching in pediatric heart transplantation does not seem to impact long-term outcomes. In younger patients, an increase in donor to recipient size ratio increases post-operative recovery. However, the use of BSA is a more reliable tool for matching heart sizes in all age groups.