Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skåne University Hospital, Lund, Sweden.
Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA; International Society for Heart and Lung Transplantation, Dallas, Texas, USA.
J Heart Lung Transplant. 2017 Sep;36(9):940-947. doi: 10.1016/j.healun.2017.02.002. Epub 2017 Feb 3.
The International Society for Heart and Lung Transplantation (ISHLT) guidelines advise against inappropriate weight match (IWM) for heart transplant, defined as donor weight <70% of recipient's weight. Few studies have explored in detail this size-matching recommendation, especially with regard to body mass index (BMI) and gender matching. We aimed to determine whether any difference could be observed between size-matching in obese and non-obese recipients with regard to mortality after cardiac transplantation.
Data from 52,455 adult heart transplants (recipients ≥18 years of age) between 1994 and 2013 were obtained from the ISHLT Registry. We defined the following subgroups of patients based on BMI: underweight, BMI <18.5; non-obese, BMI 18.5 to 30; and obese, BMI >30. The end-points were all-cause 30-day mortality and cumulative mortality.
IWM was associated with increased 30-day mortality (odds ratio [OR] = 1.20, 95% confidence interval [CI] 1.01 to 1.43, p = 0.041) and cumulative mortality (hazard ratio [HR] = 1.14, 95% CI 1.07 to 1.22, p < 0.001). In non-obese recipients, IWM was associated with increased 30-day mortality (OR = 1.89, 95% CI 1.48 to 2.41, p < 0.001) as well as cumulative mortality (HR = 1.27, 95% CI 1.15 to 1.41, p < 0.001), whereas, for obese recipients, IWM was not associated with 30-day or cumulative mortality. Male recipients of female allografts (HR = 1.08, 95% CI 1.04 to 1.12, p < 0.001) as well as female recipients of male allografts (HR = 1.07, 95% CI 1.02 to 1.13, p = 0.003) had increased cumulative mortality compared with gender-matched transplants. There was no interaction between IWM and gender mismatch.
Our results indicate that donor weight <70% of recipient weight increases mortality in non-obese heart transplant recipients, but not in obese transplant recipients. Gender mismatch increases mortality independently of weight match.
国际心肺移植学会（ISHLT）指南建议避免不适当的体重匹配（IWM）用于心脏移植，定义为供体体重<受体体重的 70%。很少有研究详细探讨这种大小匹配建议，尤其是关于体重指数（BMI）和性别匹配。我们旨在确定在肥胖和非肥胖受体中，在心脏移植后死亡率方面是否可以观察到任何与大小匹配有关的差异。
从 1994 年至 2013 年，从 ISHLT 注册处获得了 52,455 例成年心脏移植（受体≥18 岁）的数据。我们根据 BMI 将患者分为以下亚组：体重不足，BMI<18.5；非肥胖，BMI 18.5 至 30；肥胖，BMI>30。终点是全因 30 天死亡率和累积死亡率。
IWM 与 30 天死亡率增加相关（优势比[OR] = 1.20，95%置信区间[CI] 1.01 至 1.43，p = 0.041）和累积死亡率增加（风险比[HR] = 1.14，95%CI 1.07 至 1.22，p<0.001）。在非肥胖受体中，IWM 与 30 天死亡率增加相关（OR = 1.89，95%CI 1.48 至 2.41，p<0.001）以及累积死亡率增加（HR = 1.27，95%CI 1.15 至 1.41，p<0.001），而对于肥胖受体，IWM 与 30 天或累积死亡率无关。女性受体接受男性同种异体移植物（HR = 1.08，95%CI 1.04 至 1.12，p<0.001）以及男性受体接受女性同种异体移植物（HR = 1.07，95%CI 1.02 至 1.13，p = 0.003）与性别匹配的移植相比，累积死亡率增加。IWM 和性别不匹配之间没有相互作用。
我们的结果表明，供体体重<受体体重的 70%会增加非肥胖心脏移植受体的死亡率，但不会增加肥胖移植受体的死亡率。性别不匹配会增加死亡率，而与体重匹配无关。
