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Donor-recipient height ratio and outcomes in pediatric heart transplantation
Anjlee Patel1, Matthew J Bock2, Adi Wollstein3
1Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Height matching in pediatric heart transplants (HTx) for dilated cardiomyopathy (DCM) did not significantly improve long-term survival. While short-term survival showed a slight advantage for certain height ratios, other factors proved more critical in multivariate analysis.
Area of Science:
- Pediatric Cardiology
- Transplant Surgery
- Immunology
Background:
- Height matching is a proposed metric for optimizing graft size in pediatric heart transplantation (HTx).
- Limited evidence exists regarding the survival benefits of height-matched donor-recipient pairs in pediatric HTx.
- Dilated cardiomyopathy (DCM) is a common indication for pediatric heart transplantation.
Purpose of the Study:
- To investigate the hypothesis that an oversized donor improves survival in pediatric patients with DCM.
- To determine the optimal donor-recipient height ratio for pediatric HTx recipients with DCM.
- To evaluate the impact of height matching on short- and long-term survival outcomes.
Main Methods:
- Retrospective analysis of pediatric primary HTx recipients with DCM from October 1989 to September 2012 using the OPTN database.
- Stratification of patients into three donor-recipient height and weight ratio categories.
- Comparison of one- and five-year survival using Kaplan-Meier analysis and hazard ratios (HRs).
Main Results:
- Unadjusted one-year survival was worse for donor-recipient height ratios (DRHR) below 0.87 (HR, 2.15).
- This survival difference was not significant at five years post-HTx.
- Height matching lost statistical significance in multivariate analysis when adjusted for other risk factors.
Conclusions:
- Height matching may predict short-term survival better than weight matching in pediatric HTx for DCM.
- Height matching's significance diminishes when considering other crucial risk factors in multivariate models.
- Factors beyond donor-recipient height ratio play a more significant role in long-term transplant survival for pediatric DCM patients.
Abstract:
Height matching in pediatric HTx has been proposed as a superior method of evaluating graft size, but no studies have examined survival advantage for height-matched donor-recipient pairs. We hypothesized that in pediatric patients with DCM, an oversized donor improves survival and aimed to define the optimal height ratio in this patient group. Pediatric primary HTx recipients with DCM between 10/89 and 09/12 were identified in the OPTN database. Patients were stratified into three donor-recipient height and weight ratio categories. One- and five-yr survival was compared using Kaplan-Meier analysis and HRs were computed. A total of 2133 children with DCM who underwent HTx during the study period were included. Unadjusted one-yr survival was worse for DRHR <0.87 (HR, 2.15 [95% CL, 1.30, 3.53]; p < 0.01). This difference was not present at five yr post-HTx or when stratified by weight. After adjustment for other risk factors affecting transplant survival, height matching was no longer significant. Although height matching appears to predict short-term survival better than weight in pediatric HTx recipients with DCM, other factors play a more important role as height matching loses significance in multivariate analysis.
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