Abstract
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 <18yrs 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.
Highlights
Transplant centers routinely provide a weight-range for an acceptable donor when listing a candidate for heart transplant (HT)
After investigators of a population-based study (Multi Ethnic Study of Atherosclerosis) in the United States (US) performed cardiac magnetic resonance imaging (MRI) in healthy adults to develop normative equations for left ventricular (LV) and right ventricular (RV) mass using age, gender, height and weight [4, 5], several HT investigators have evaluated the role of predicted heart mass as a potential metric for DR size match in adult HT. These analyses have found that recipients with hearts from undersized donors using this metric had significantly worse 1-year HT survival whereas size match assessed using weight, height, body surface area (BSA) or body mass index in the same patient population was not related [6]
These findings are different from analyses in adult HT recipients where use of predicted heart mass formula to assess DR size match is superior to using body measurements
Summary
Transplant centers routinely provide a weight-range for an acceptable donor when listing a candidate for heart transplant (HT). 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. It may be that body measurements such as weight or height may not be the best metrics to assess the association of DR size mismatch with outcomes
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