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Published on: June 26, 2020
Weight Matching in Infant Heart Transplantation: A National Registry Analysis
James Y Lee1, Sumanth Kidambi1, Roy S Zawadzki2
1Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California.
Insights
Modest donor oversizing in infant heart transplantation, defined by donor-to-recipient weight ratio (DRWR) between 1.29-1.97, improves graft survival and reduces risk. Further research is needed to optimize size matching for better outcomes.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Immunology
Background:
- Infants represent a significant portion of pediatric heart transplant recipients.
- High waitlist mortality is a critical issue in infant heart transplantation.
- Current practices often involve donor oversizing based on weight criteria in this population.
Purpose of the Study:
- To investigate the impact of donor oversizing on outcomes in infant heart transplantation.
- To analyze the relationship between donor-to-recipient weight ratio (DRWR) and graft survival.
Main Methods:
- Retrospective analysis of infant heart transplantations from the United Network for Organ Sharing (UNOS) database (January 1994 - September 2019).
- Categorization of 2384 recipients into quintiles based on DRWR.
- Multivariate Cox regression analysis to assess the effect of DRWR on 1-year graft survival.
Main Results:
- Quintiles 3 and 4 (DRWR 1.29-1.97) demonstrated improved survival compared to lower and the highest quintiles.
- Regression analysis indicated that DRWR in quintiles 3 and 4 was protective against graft failure.
- Significant factors influencing outcomes included primary diagnosis, ischemia time, bilirubin levels, and transplant year.
Conclusions:
- A modest degree of donor oversizing (DRWR 1.29-1.97) is associated with enhanced survival in infant heart transplantation.
- This finding suggests an optimal range for size matching in this vulnerable patient group.
- Further research is essential to establish definitive best practices for donor-recipient size matching in infant heart transplantation.
Background:
Infants account for a significant proportion of pediatric heart transplantation but also suffer from a high waitlist mortality. Donor oversizing by weight-based criteria is common practice in transplantation and is prevalent in this group. We sought to analyze the impact of oversizing on outcomes in infants.
Methods:
Infant heart transplantations reported to the United Network for Organ Sharing from January 1994 to September 2019 were retrospectively analyzed. 2384 heart transplantation recipients were divided into quintiles (Q1-Q5) on the basis of donor-to-recipient weight ratio (DRWR). Multivariate Cox regression was used to estimate the effect of DRWR. The primary end point was graft survival at 1 year.
Results:
The median DRWR for each quintile was 0.90 (0.37-1.04), 1.17 (1.04-1.29), 1.43 (1.29-1.57), 1.74 (1.58-1.97), and 2.28 (1.97-5.00). Pairwise comparisons showed improved survival for Q3 and Q4 over each of the bottom 2 quintiles and the top quintile. Regression analyses found that Q3 and Q4 were protective against graft failure compared with the bottom 2 quintiles. There was no difference in hazard among the top 3 quintiles. Significant covariates included primary diagnosis, ischemia time, serum bilirubin level, transplantation year, mechanical ventilation at transplantation, and extracorporeal membrane oxygenation at transplantation. Sex, female-to-male transplantation, and mechanical circulatory support at transplantation were not significant in univariate analyses.
Conclusions:
Modest oversizing by DRWR (1.29-1.97) is associated with increased survival and lower risk in infant heart transplantation. Additional investigation is needed to establish best practices for size matching in this population.
