Donor predicted heart mass as predictor of primary graft dysfunction
Related Experiment Video
Updated: Feb 11, 2026

Author Spotlight: Enhancing Donor Heart Preservation Through Isolated Rat Heart Perfusion Studies
Published on: October 4, 2024
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.
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.
Background:
Concern over the hazards associated with undersized donor hearts has impeded the utilization of otherwise viable allografts for transplantation. Previous studies have indicated predicted heart mass (PHM) may provide better size matching in cardiac transplantation than total body weight (TBW). We investigated whether size-matching donor hearts by PHM is a better predictor of primary graft dysfunction (PGD) than matching by TBW.
Methods:
Records of consecutive adult cardiac transplants performed between 2012 and 2016 at a single-center academic hospital were reviewed. We compared patients implanted with hearts undersized by ≥30% with those implanted with donor hearts matched for size (within 30%), and performed the analysis both for undersizing by PHM and for undersizing by TBW. The primary outcome was moderate/severe PGD within 24 hours, according to the 2014 International Society for Heart and Lung Transplantation consensus. Secondary outcome was 1-year survival.
Results:
Of 253 patients, 21 (8%) and 30 (12%) received hearts undersized by TBW and PHM, respectively. The overall rate of moderate/severe PGD was 13% (33 patients). PGD was associated with undersizing if performed by PHM (p = 0.007), but not if performed by TBW (p = 0.49). One-year survival was not different between groups (log-rank, p > 0.8). Multivariate analysis confirmed that undersizing donor hearts by PHM, but not by TBW, was predictive of moderate/severe PGD (OR 3.3, 95% CI 1.3 to 8.6).
Conclusions:
Undersized donor hearts by ≥30% by PHM may increase rates of PGD after transplantation, confirming that PHM provides more clinically appropriate size matching than TBW. Better size matching may ultimately allow for expanding the donor pool.
Related Concept Videos
Predicting Molecular Geometry
Prediction Intervals
However, the point estimate is most likely not the exact value of the population parameter, but close to it. After calculating point estimates, we construct interval estimates, called confidence intervals or prediction intervals. This prediction interval comprises a range of values unlike the point estimate and is a better predictor of the observed sample value, y.
Anatomy of the Heart
Atomic Mass
Molar Mass
Sensitivity, Specificity, and Predicted Value
Sensitivity is the...

