Donor-Recipient Weight Match in Pediatric Heart Transplantation: Liberalizing Weight Matching with Caution

Area of Science:

• Cardiology
• Transplantation Surgery
• Pediatric Medicine

Background:

• Donor heart scarcity necessitates expanding donor criteria in heart transplantation (HTx).
• Data on the feasibility of donor and recipient weight ratios (DRWR) exceeding 30% in pediatric HTx, particularly in China, remains limited.
• The upper limit for acceptable DRWR in pediatric HTx is debated, with potential risks associated with wider ratios.

Purpose of the Study:

• To evaluate the safety and feasibility of utilizing donor hearts with a donor and recipient weight ratio (DRWR) greater than 30% in pediatric heart transplantation (HTx).
• To analyze the impact of expanded DRWR on survival outcomes in pediatric heart transplant recipients.

Main Methods:

• A retrospective analysis of 78 pediatric patients (<18 years) who underwent HTx between 2015 and 2020.
• Patients were categorized into two groups based on DRWR: >30% and ≤30%.
• Univariate, multivariate, and Kaplan-Meier survival analyses were performed to compare outcomes between groups.

Main Results:

• No significant differences in one-year, three-year, or five-year survival rates were observed between the DRWR >30% and ≤30% groups.
• The study suggests that expanding the DRWR to over 30% is acceptable in pediatric HTx.

Conclusions:

• The expansion of donor and recipient weight ratios (DRWR) to over 30% is a viable strategy for pediatric heart transplantation (HTx) in China.
• While a liberal upper DRWR boundary (e.g., >200%) may serve as a last resort, its application requires careful consideration and caution.