Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
J Heart Lung Transplant. 2019 Feb;38(2):156-165. doi: 10.1016/j.healun.2018.09.017. Epub 2018 Sep 27.
Donor-recipient size match is traditionally assessed by body weight. We assessed the ability of 5 size match metrics-predicted heart mass (PHM), weight, height, body mass index (BMI) and body surface area (BSA)-to predict 1-year mortality after heart transplant and to assess the effect of size match on donor heart turn down for size.
The study cohort comprised 19,168 adult heart transplant recipients in the United Network for Organ Sharing registry between 2007 and 2016. Each size match metric was divided into 7 equally sized groups using the donor-recipient ratio for each metric. Single and multivariable Cox proportional hazard models for mortality 1 year after transplant were constructed.
Recipients in the severely (donor-recipient PHM ratio 0.54-0.86) undersized group for PHM experienced increased mortality, with a hazard ratio of 1.34 (95% confidence interval, 1.13-1.59; p < 0.001). There was no increased risk of death at 1 year if donors were undersized for weight, height, BMI, or BSA. We found that 32% of heart offers turned down for donor size would be acceptable using a PHM threshold of 0.86 or greater and that 14% of offers accepted (most of which are female donor to male recipient) were below this threshold.
PHM is the optimal donor-recipient size match metric for prediction of mortality after heart transplant. Many offers turned down for donor size were above the threshold for adequacy of size match by PHM identified, and thus, the use of PHM could improve donor heart utilization and post-transplant survival.
传统上，供体-受体大小匹配是通过体重来评估的。我们评估了 5 种大小匹配指标（预测心脏质量[PHM]、体重、身高、体重指数[BMI]和体表面积[BSA]）预测心脏移植后 1 年死亡率的能力，并评估大小匹配对供体心脏因大小不匹配而被拒绝的影响。
本研究队列包括 2007 年至 2016 年美国器官共享网络登记处的 19168 例成年心脏移植受者。对于每种指标，均根据供体-受体比值将每个指标分为 7 个大小相等的组。构建了单变量和多变量 Cox 比例风险模型来预测移植后 1 年的死亡率。
PHM 严重（供体-受体 PHM 比值为 0.54-0.86）不足的组患者，其 PHM 死亡率增加，风险比为 1.34（95%置信区间，1.13-1.59；p<0.001）。如果供体体重、身高、BMI 或 BSA 不足，1 年内死亡的风险没有增加。我们发现，使用 PHM 阈值为 0.86 或更高的标准，有 32%的因供体大小不合适而被拒绝的心脏供体是可以接受的，而 14%被接受的供体（其中大部分是女性供体给男性受体）低于这一标准。
PHM 是预测心脏移植后死亡率的最佳供体-受体大小匹配指标。许多因供体大小不合适而被拒绝的供体中，有很大一部分（32%）的 PHM 大小匹配程度超过了所确定的合适阈值，因此，使用 PHM 可以提高供体心脏的利用率和移植后的生存率。
