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Impact of Predicted Heart Mass-Based Donor-Recipient Size Matching on Transplant Outcomes
Gregorio Gliozzi1, Antonio Loforte1, Carlo Mariani1
1Division of Cardiac Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna Policlinico di S. Orsola, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Insights
Predicted heart mass (pHM) matching in heart transplant (HT) recipients shows that a wide range of donor-recipient pHM ratios is safe. Careful organ allocation considering pHM mismatch can optimize HT outcomes.
Area of Science:
- Cardiology
- Transplantation Surgery
- Medical Statistics
Background:
- Current heart transplant (HT) donor selection primarily relies on donor-recipient body weight matching.
- This approach may not fully account for anatomical variations influencing transplant success.
Purpose of the Study:
- To retrospectively evaluate the impact of predicted heart mass (pHM)-based donor-recipient size matching on HT outcomes.
- To determine if pHM ratio influences early graft failure and mortality after heart transplantation.
Main Methods:
- Analysis of 512 adult HT recipients from January 2000 to August 2020.
- Calculation of donor-recipient pHM ratios and categorization into quintiles (undersizing 2 to oversizing 2).
- Assessment of severe early graft failure, and 30-day, 90-day, 1-year, and 10-year mortality rates.
Main Results:
- The most oversized group (higher pHM ratio) included more females, had higher pulmonary vascular resistance, and required more mechanical support.
- Pulmonary vascular resistance, mechanical support, and United Network for Organ Sharing score were risk factors for early mortality.
- Donor-recipient pHM ratio did not significantly impact early graft failure or early mortality (P > .5).
Conclusions:
- A broad spectrum of donor-recipient pHM ratios appears safe in heart transplantation.
- Organ allocation strategies can be refined by considering pHM ratio to balance recipient needs and donor characteristics, potentially preserving HT outcomes.
Background:
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.
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 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.
Results:
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.
Conclusions:
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.
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