Donor predicted heart mass as predictor of primary graft dysfunction

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Timothy A Gong1, Susan M Joseph1, Brian Lima2

  • 1Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA; Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|April 28, 2018
PubMed

Insights

Using predicted heart mass (PHM) for donor heart size matching significantly increases the risk of primary graft dysfunction (PGD) after cardiac transplantation compared to total body weight (TBW). This finding suggests PHM is a better predictor of PGD.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Medical Research

Background:

  • Undersized donor hearts pose risks in transplantation, limiting the use of viable allografts.
  • Predicted heart mass (PHM) may offer superior size matching for cardiac transplants over total body weight (TBW).

Purpose of the Study:

  • To investigate if PHM is a better predictor of primary graft dysfunction (PGD) than TBW when matching donor heart size.

Main Methods:

  • Reviewed adult cardiac transplants (2012-2016) at a single academic center.
  • Compared outcomes for hearts undersized by ≥30% (by PHM and TBW) versus size-matched hearts.
  • Assessed moderate/severe PGD within 24 hours and 1-year survival.

Main Results:

  • PHM-based undersizing (30 hearts) was associated with PGD (p=0.007), unlike TBW-based undersizing (21 hearts, p=0.49).
  • Multivariate analysis confirmed PHM undersizing predicted PGD (OR 3.3), but TBW undersizing did not.
  • One-year survival rates did not differ significantly between groups.

Conclusions:

  • Donor hearts undersized by ≥30% based on PHM increase PGD rates, indicating PHM is a more appropriate size-matching metric than TBW.
  • Improved size matching using PHM could potentially expand the donor heart pool.
Abstract

Keywords:
cardiac transplantationdonorsgraft failureheart massoutcomes

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