Donor-recipient Body Weight Research Articles

#2040 Effect of donor–recipient size mismatch on long-term graft survival in pediatric kidney transplantation: a multicenter cohort study

Abstract Background and Aims Kidney transplantation (KT) is the main treatment option for patients with end-stage kidney disease (ESKD). However, it is limited by the low number of donor organs. Moreover, donor–recipient size mismatching is a common problem in KT given the various types of donors. Donor–recipient size mismatching is commonly occurs in pediatric kidney transplantation (KT). However, its effect on graft survival remains unknown. This study aimed to determine the effect of donor–recipient size mismatch on the long-term survival rate of transplant kidneys in pediatric KT. Method A total of 241 pediatric patients who received KT were enrolled. The medical records of all patients were retrospectively reviewed, and the correlation between donor–recipient size mismatch and graft function and long-term graft outcome was analyzed according to donor–recipient size mismatch. Results Recipients and donors’ mean body weight at the time of KT were 34.31 ± 16.85 and 56.53 ± 16.73 kg, respectively. The mean follow-up duration was 96.49 ± 52.98 months. The mean age of donors was 34.74 ± 14.91 years, and the ratio of males and females was 105:136. Approximately 81.7%, 1.2%, and 17.0% of all transplant donors were identified as living-related, living-unrelated, and deceased donors, respectively. A significant positive correlation was observed between donor–recipient body weight ratio (DRBWR) or donor–recipient body surface area ratio (DRBSR) and graft function until 1 year after KT. However, this correlation could not be confirmed at the last follow-up. The results of long-term survival analysis using Fine and Gray's subdistribution hazard model showed no significant difference of the survival rate of the transplant kidney according to DRBWR or DRBSR. Conclusion Donor–recipient size mismatch in pediatric KT is not an important factor in determining the long-term prognosis of transplant kidneys.

Effect of donor-recipient size mismatch on long-term graft survival in pediatric kidney transplantation: a multicenter cohort study.

Donor-recipient size mismatching is commonly occurs in pediatric kidney transplantation (KT). However, its effect on graft survival remains unknown. This study aimed to determine the effect of donor-recipient size mismatch on the long-term survival rate of transplant kidneys in pediatric KT. A total of 241 pediatric patients who received KT were enrolled. The medical records of all patients were retrospectively reviewed, and the correlation between donor-recipient size mismatch and graft function and long-term graft outcome was analyzed according to donor-recipient size mismatch. Recipients and donors' mean body weight at the time of KT were 34.31 ± 16.85 and 56.53 ± 16.73 kg, respectively. The mean follow-up duration was 96.49 ± 52.98 months. A significant positive correlation was observed between donor-recipient body weight ratio (DRBWR) or donor-recipient body surface area ratio (DRBSR) and graft function until 1 year after KT. However, this correlation could not be confirmed at the last follow-up. The results of long-term survival analysis using Fine and Gray's subdistribution hazard model showed no significant difference of the survival rate of the transplant kidney according to DRBWR or DRBSR. Donor-recipient size mismatch in pediatric KT is not an important factor in determining the long-term prognosis of transplant kidneys.

Impact of Predicted Heart Mass–Based Donor-Recipient Size Matching on Transplant Outcomes

Currently, guidelines for appropriate donor sizing in recipients mostly focuses on donor-recipient body weight matching. The purpose is to retrospectively determine the impact of predicted heart mass (pHM)-based size matching on heart transplant (HT) outcomes. According to our institutional registry, 512 consecutive adult patients underwent HT between January 2000 and August 2020. For each patient, pHM and donor-recipient pHM ratio were calculated. Patients were partitioned into quintiles in terms of pHM ratio: undersizing 2, undersizing 1, reference, oversizing 1, and oversizing 2, with mean pHM donor-recipient ratio of 0.81, 0.96, 1.04, 1.12, and 1.28, respectively. Severe early graft failure and 30-day, 90-day, 1-year, and 10-year mortality were analyzed as outcomes. Recipients of the most oversized group were mostly female (P < .001), had higher preoperative pulmonary vascular resistance (P=.009), had higher rate of mechanical circulatory support (P < .05), and showed a lower United Network for Organ Sharing score (P=.041); the respective donors were younger and more frequently male (P=.001). Ischemic time was similar in all groups (P=.358). Pulmonary vascular resistance (P=.023; odds ratio [OR], 2.38), preoperative mechanical circulatory support (P=.05; OR, 3.06), and United Network for Organ Sharing score (P=.033; OR, 1.76) were identified as risk factors for early mortality. Donor-recipient pHM ratio did not impact early graft failure (P=.871) and early mortality (P=.526). Survival analysis after adjustment for pHM ratio subgroups did not show any difference in outcomes. A wide range of pHM ratios seems to be safe. A careful allocation of organs, by considering a pHM ratio mismatch, may balance rescue preoperative clinical profiles and preserve HT outcomes.

Impact of Predicted Heart Mass−Based Size Matching for Donor-Recipient Selection on Transplant Outcomes

Purpose Currently, guide for appropriate donor sizing in recipients mostly focuses on donor-recipient body weight matching. The purpose is to retrospectively determine the impact of predicted heart mass (pHM)-based size matching among recipients on heart transplantation (HT) outcomes. Methods According to our institutional registry, 512 consecutive adult patients underwent HT between January 2000 and August 2020. For each patient, pHM and donor-recipient pHM ratio have been calculated (4 patients were excluded for missing anthropometric data). Patients were partitioned into quintiles in terms of pHM ratio: Undersizing2 (n=101), Undersizing1 (n=102), Reference (n=102), Oversizing1 (n=102), Oversizing2 (n=101) with a mean pHM donor-recipient ratio of 0.81, 0.96, 1.04, 1.12, 1.28, respectively. Severe early graft failure, 30-day, 90-day and 1-year mortality were analyzed as early outcomes. Results Several characteristics were significantly different between groups. Recipients of the most oversized group were mostly male (p 0.05). Kaplan-Mayer and Cox-regression analysis after adjustment for pHM ratio subgroups did not show any difference in outcomes (p>0.05). Conclusion A wide range of pHM donor-recipient ratios seem to be safe (0.81-1.28). Providing a pHM-based oversized graft to more compromised patients may preserve good outcomes. Instead, low risk profile patients may have acceptable outcomes even in the presence of extremely undersized pHM ratio calculation. A careful allocation of organs, by considering a pHM ratio mismatch, may balance rescue preoperative clinical profiles and preserve HT outcomes.

Whole liver deceased donor liver transplantation for pediatric recipients: single-center experience for 20 years.

BackgroundWe investigated the incidence and outcomes of pediatric deceased donor liver transplantation (DDLT) using whole liver grafts in a high-volume liver transplantation (LT) center.MethodsThe study was a retrospective single-center analysis of whole LT in pediatric recipients. The study period was set as 20 years between January 2000 and December 2019. We defined pediatric recipients and donors to be aged ≤18 years.ResultsDuring the study period, there were 98 cases of pediatric DDLT, and 34 patients (34.7%) received whole liver grafts. The age range of the deceased donors was 3 months to 56 years and that of pediatric recipients was 7 months to 17 years. Common primary diseases for LT were biliary atresia in 13, acute liver failure in four, Wilson disease in four, congenital portal vein agenesis in three, and genetic metabolic diseases in three. Pediatric-to-pediatric and adult-to-pediatric whole LTs were 22 (64.7%) and 12 (35.3%), respectively. A good correlation was noted between the donor and the recipient’s body weight, and the recipient’s body weight and allograft’s weight. Graft and overall patient survival rates were 91.2% and 91.2% at 1 year, 88.0% and 88.0% at 3 years, and 88.0% and 88.0% at 5 years, respectively.ConclusionsThe results of this study revealed that Korean Network for Organ Sharing (KONOS) regulations with donor-recipient body weight matching exhibited good performance. Considering the reciprocal trades of liver organs among pediatric and adult donors and recipients, it is necessary to establish a policy for pediatric donor liver grafts to pediatric recipients on a priority basis.

Whole liver deceased donor liver transplantation for pediatric recipients: single-center experience for 20 years

Background: We investigated the incidence and outcomes of pediatric deceased donor liver transplantation (DDLT) using whole liver grafts in a high-volume liver transplantation (LT) center. Methods: The study was a retrospective single-center analysis of whole LT in pediatric recipients. The study period was set as 20 years between January 2000 and December 2019. We defined pediatric recipients and donors to be aged ≤18 years. Results: During the study period, there were 98 cases of pediatric DDLT, and 34 pa tients (34.7%) received whole liver grafts. The age range of the deceased donors was 3 months to 56 years and that of pediatric recipients was 7 months to 17 years. Common primary diseases for LT were biliary atresia in 13, acute liver failure in four, Wilson dis ease in four, congenital portal vein agenesis in three, and genetic metabolic diseases in three. Pediatric-to-pediatric and adult-to-pediatric whole LTs were 22 (64.7%) and 12 (35.3%), respectively. A good correlation was noted between the donor and the re cipient’s body weight, and the recipient’s body weight and allograft’s weight. Graft and overall patient survival rates were 91.2% and 91.2% at 1 year, 88.0% and 88.0% at 3 years, and 88.0% and 88.0% at 5 years, respectively. Conclusions: The results of this study revealed that Korean Network for Organ Sharing (KONOS) regulations with donor-recipient body weight matching exhibited good perfor mance. Considering the reciprocal trades of liver organs among pediatric and adult do nors and recipients, it is necessary to establish a policy for pediatric donor liver grafts to pediatric recipients on a priority basis.

Plerixafor-based mobilization in pediatric healthy donors with unfavorable donor/recipient body weight ratio resulted in a better CD34+ collection yield: A retrospective analysis.

In order to propose risk-adapted mobilization algorithms, several authors have tried to look for predictive factors of the CD34+ yield in healthy pediatric donors. Donor recipient body weight ratio (D/R ratio) was identified as one of the main variables related with the success to achieve the target cell dose for transplantation. According to this variable we modified the mobilization schedule. We report the results of 46 mobilizations and apheresis procedures performed in our center with unfavorable D/R ratio. Mobilization was attempted by the standard regime of G-CSF (10 mcg/kg/24 hours) in 28 cases (60.9%), with high dose G-CSF (10 mcg/kg/12 hours) in 9 cases (19.6%), and with plerixafor and G-CSF single dose regime in 9 cases (19.6%). CD34+ cell quantification before apheresis is closely related to CD34+ yield, being the only factor related to collected CD34+ cells (beta .71; P < .0001). The mobilization efficiency was higher in plerixafor group compared to the other two schedules (P < .0001). By using plerixafor for mobilization, we achieved the target CD34+ cell dose of ≥2 × 106 /kg per recipient body weight in all cases with unfavorable D/R ratio. It was observed that 17.4% of cases that not reached the established target cell dose were located in the standard or high-dose mobilization regimes. This difference is even greater for optimal collections (≥5 × 106 /kg), since of the 54.3% cases that did not reach this goal none was mobilized by plerixafor. Tailoring the mobilization regime we can reach the target cell dose, even in those cases with the worst D/R ratio.

Donor-Recipient Body Weight Mismatch May Affect Glomerular Basement Membrane Thinning in Electron Microscopic Examination of 1-Hour Renal Allograft Biopsy Specimens

BackgroundAlthough an association between body weight mismatch and impaired graft function has been reported, few histologic studies have evaluated this issue, especially using electric microscopic analysis. During routine observations, we have noted a thin glomerular basement membrane (GBM) in the 1-hour biopsy specimen in cases with an overweight recipient and a lightweight donor. Therefore, we hypothesized that donor-recipient body weight mismatch affects the GBM thickness in the 1-hour biopsy specimen. The aim of the present study was to clarify the effect of donor-recipient body weight mismatch on the GBM thickness of the 1-hour biopsy specimen measured using electron microscopy. MethodsWe used an electron microscope to measure the GBM thickness of specimens at 1-hour post-transplantation (n = 24) and at 1 year post-transplantation (n = 17). The GBM thickness of cases with donor-recipient body weight mismatch was compared with those without mismatch. In accordance with a previous study, we defined a donor/recipient body weight ratio of less than 0.9 as donor-recipient body weight mismatch and a ratio of more than 0.9 as no mismatch. ResultsAt 1-hour post-transplantation, the mean GBM was significantly thinner in the mismatch group than in the nonmismatch group. However, at 1-year post-transplantation, the mean GBM thickness did not significantly differ between the 2 groups. ConclusionsThe GBM thickness at 1-hour post-transplantation is thinner in cases with donor-recipient body weight mismatch than in cases without mismatch. This implies that donor-recipient body weight mismatch may have to be considered when assessing donor-derived thin GBM disease using the 1-hour biopsy specimen.

Alternative methods for virtual heart transplant-Size matching for pediatric heart transplantation with and without donor medical images available.

Listed pediatric heart transplant patients have the highest solid-organ waitlist mortality rate. The donor-recipient body weight (DRBW) ratio is the clinical standard for allograft size matching but may unnecessarily limit a patient's donor pool. To overcome DRBW ratio limitations, two methods of performing virtual heart transplant fit assessments were developed that account for patient-specific nuances. Method 1 uses an allograft total cardiac volume (TCV) prediction model informed by patient data wherein a matched allograft 3-D reconstruction is selected from a virtual library for assessment. Method 2 uses donor images for a direct virtual transplant assessment. Assessments were performed in medical image reconstruction software. The allograft model was developed using allometric/isometric scaling assumptions and cross-validation. The final predictive model included gender, height, and weight. The 25th-, 50th-, and 75th-percentiles for TCV percentage errors were -13% (over-prediction), -1%, and 8% (under-prediction), respectively. Two examples illustrating the potential of virtual assessments are presented. Transplant centers can apply these methods to perform their virtual assessments using existing technology. These techniques have potential to improve organ allocation. With additional experience and refinement, virtual transplants may become standard of care for determining suitability of donor organ size for an identified recipient.

Cardiac Transplantation Can Be Safely Performed With Low Donor-to-Recipient Body Weight Ratios

BackgroundUnited Network for Organ Sharing adult heart transplant criteria recommend against using same-sex donors with a donor-recipient body weight ratio <0.7. The same criteria recommend against a female donor to male recipient body weight ratio <0.9. We attempted to determine if transplantation with low donor-recipient body weight ratios can be safely performed. Methods and ResultsTransplants with same-sex donor-recipient body weight ratio <0.7 and female donor–male recipient body weight ratio <0.9 were compared with age- and sex-matched control subjects with ideally matched donor weights. Of the 123 patients undergoing transplantation, 23 met low donor-recipient body weight ratio criteria. This cohort was compared with 22 ideally weight-matched patients. There was no difference in survival at 1, 5, and 10 years (P = .68). Freedom from rejection (52.2 vs 50.0%; P = 1.0), creatinine clearance change (−1.3 vs 5.7 mL/min; P = .88), duration of inotropic support (191.5 vs 208.8 h; P = .65), and duration of mechanical ventilation (156.3 vs 84.5 h; P = .52) were similar. Intensive care (290.5 vs 368.6 h; P = .71) and hospital length of stay (35.4 vs 36.7 d; P = .94) were not different. ConclusionsAccepted donor-recipient weight match criteria may be extended to increase the donor pool.

Increasing donor-recipient weight mismatch in pediatric orthotopic heart transplantation does not adversely affect outcome

The aim of the study was to show the effect of heart transplant donor-recipient weight mismatch on mortality, right-ventricular (RV) failure, and medium-term control of systemic blood pressure. From 2000 to 2008 inclusive, 161 patients undergoing orthotopic heart transplantation at our unit were retrospectively analyzed. The cohort was divided into three groups of similar size depending on the tertile ranges of the donor-recipient weight ratio. Median follow-up was 4.81 years. Donor-recipient body weight ratio was analyzed with respect to intubation time, time in intensive care unit (ITU), development of RV failure, medium-term survival, and freedom from medium-term hypertension. The median age was 115 months (23 days to 18 years), at a median weight of 26.9 kg (3-88 kg) at transplant. Median donor-recipient weight ratio was 1.61 (0.62-3.25). Mean intubation time was 448 h (SD 749.2), mean time in the ITU 302.7 h (SD 617.8). On linear regression, these were not related to donor-recipient weight ratio. A total of 38 patients (23.6%) developed postoperative RV failure. Nearly one-fifth (18.9) of patients in the lowest tertile group developed RV failure. In the middle tertile group, 24.5% developed RV failure and 28.8% in the upper tertile of weight mismatch, although this was not statistically significant (p = 0.48). On survival analysis, there was a higher mortality among those with the lowest tertile of mismatch (log-rank p = 0.04), but there was no difference in midterm survival on condition of survival to discharge (log-rank p = 0.14). There was also no association between weight ratio and freedom from medium-term hypertension as measured on serial 24-h ambulatory blood pressure monitoring (log-rank p = 0.39). There were nine patients in whom the weight mismatch was 3 or greater. There was no association between this 'extreme' mismatch group and either midterm mortality (p = 0.76) or freedom from hypertension (p = 0.62), but this was associated with the need for postoperative extracorporeal membrane oxygenator (ECMO) support (p < 0.01). Our current policy involves accepting a maximum donor-recipient weight ratio of 3. These encouraging findings cautiously justify this policy, in an era when marginal donors are increasingly sought.

The Influence of Donor Characteristics on Survival After Heart Transplantation

With improved immunosuppressive regimens, transplantation techniques, and postoperative care, heart transplantation (HTx) has been established as a definite therapy for end-stage heart disease. Because of a donor shortage, we have accepted marginal individuals. In this study, we identified donor-related factors influencing survival after HTx by retrospective analysis of recipient data after primary HTx from February 2002 to December 2006. The Cox regression model was used to examine the effects of the following variables on survival of 112 heart transplant recipients: demographic data of gender, age, body weight, donor–recipient body weight ratio; history of smoking, alcohol drinking, diabetes mellitus, hypertension, hepatitis B surface antigen, anti-hepatitis C virus antibody; donor condication before transplantation including catecholamine doses, hypotension, cardiopulmonary resuscitation, creatine MB isoenzyme of creatine kinase (CK-MB), tropinin I, and cold ischemic time of the allograft. Catecholamines and smoking showed significant influences on HTx survival. In our series, the percentage of donors receiving inotropic support before donation was 88% ( n = 99), and the percentage of donors with a history of smoking was 25% ( n = 28). There was no influence of donor status of diabetes, hypertension, or hepatitis B or C infection on postoperative survival. Our results showed that inotropic support of and a history of smoking by the donor were significant factors influencing posttransplant survival.

Single-Center Experience of Pediatric Heart Transplantation in Taiwan

Heart transplantation (HTx) is a treatment for end-stage heart failure or a complex or inoperable congenital defect. The long-term survival and the adequate donor to recipient body weight (D/R BW) ratio remain to be determined. From March 1995 to May 2004, 14 children (6 months–16 years of age) underwent HTx due to underlying diseases of idiopathic dilated cardiomyopathy ( n = 10; 71.4%), congenital heart disease ( n = 3; 21.4%), and Kawasaki disease ( n = 1; 7.1%). Donor-recipient body weight ratio ranged from 0.89 to 3.9. Big heart syndrome was present in one patient when D/R BW ratio was more than 3. Actuarial survival was 92.9% at 5 years after transplantation. Only the one patient who had Kawasaki disease died due to early primary graft failure. HTx is a feasible method with good long-term survival rates for end-stage heart failure or for complex or inoperable congenital defects. After careful pretransplant evaluation, a high D/R BW ratio (more than 3) is acceptable.

CAN WE PREVENT CHRONIC GRAFT LOSS? STRATEGIES AND OUTCOME IN 1000 LIVE RELATED RENAL TRANSPLANTS FROM A DEVELOPING COUNTRY

P266 Aims: This study describes strategies to prevent graft loss in a living related programme from a developing country. Methods: One thousand and forty five live related transplants were performed between 1985 and 2001. Analysis of survival was divided into three periods (1986 – 1993) 184 transplants, (1994 – 1997) 350 and (1998 – 2001) 511 transplants. Strategy included young donor selection, matching donor recipient body weight ratio, improvement in histocompatibility by DNA typing and flow cross match. Tailoring immunosuppression by ATG, IL2 induction, switch from Aza to MMF and CyA reduction, HLA match and donor age. Early diagnosis of dysfunction by imaging and frequent biopsy. Molecular diagnosis of TB, CMV and HCV, stringent control of hypertension, treatment of hyperlipidaemia and diet control. Maintenance immunosuppression was by triple drug regimen. Statistical methods used were Kaplan Meier, Log rank and Cox analysis. Results: Analysis of 1 and 5 year graft survival in the three eras showed that it was 80% and 51% in the first (1986-1993), 89% and 69% in second (1994-1997) and 92% and 81% in the third period (1998-2001). Age of donors was < 30 years in 34% in the first era and this increased to 40% in the third era while age > 50 years decreased from 13% to 8%. ATG and IL2 induction allowed use of poorly matched donors. In the first era there were 4% (1-2 antigen matched transplants) and 29% identical. This changed to 12% (1-2 antigen matched) and 18% identical in the third era. Graft loss due to chronic rejection reduced from 60.2% in the first era to 26% in second and 12.9% in the 3rd era. Of the total graft losses of 198, 46% were due to chronic rejection and 27% were due to death with graft function where the main reason was infection in 61%. Conclusions: In a living related programme graft loss equates with end of life. We feel that attempts can be to salvage a good proportion of grafts by early diagnosis and effective therapy of rejection, individualized immunosuppression, prevention of graft threatening infections, hypertension and hyperlipidaemia. Knowing limitations inherent in the available donor strategies can be developed to prolong graft survival.

Análisis de los factores que pueden influir en la aparición del fallo agudo del corazón trasplantado

Acute graft failure (AGF) is defined as significant failure of myocardial function in a newly implanted heart. The aim of the present study was to investigate a series of factors related to heart transplantation (HT) in relation to AGF. In a study of 287 consecutive HTs performed over a 14-year period, AGF was defined when: a) the surgeon observed ventricular dysfunction before closing the sternotomy; b) various inotropic drugs were required at high doses in the first days after surgery, or c) ventricular dysfunction was identified by routine echocardiography in the immediate postoperative period. Statistical analysis comprised a descriptive and univariate comparative study, followed by multivariate analysis based on application of a logistical regression model. The incidence of AGF was 22%. Predictors of AGF were female donor status (OR = 2.2; 95% CI, 1.2-4.4; p = 0.02), a disproportion of more than 20% in donor-recipient body weight (OR = 2.2; 95% CI, 1.1-4.3; p = 0.02), and background ischemic heart disease (OR = 2.5; 95% CI, 5.5-1.1; p = 0.03) or valve pathology (OR = 5.0; 95% CI, 7.0-1.5; p = 0.01). AGF is a frequent pathology, which was present in 22% of our heart transplantation patients. Among the modifiable factors related to AGF was a clear disproportion in body weight and the size of grafts from female donors. Unmodifiable factors related to AGF were ischemic heart disease and valvular heart disease as a cause of heart transplantation.