Division of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio.
College of Medicine, University of Cincinnati, Cincinnati, Ohio.
J Thorac Cardiovasc Surg. 2019 Dec;158(6):1652-1660.e4. doi: 10.1016/j.jtcvs.2019.06.037. Epub 2019 Jul 2.
Accurately predicting cardiac size by other body parameters has long been problematic to determine whether a donor heart will serve a given waitlist candidate, yet hundreds of heart donors are turned down annually for size mismatch.
We sought to describe how donor body weight parameters are currently utilized in cardiac transplantation and its influence on waitlist outcomes.
From the United Network for Organ Sharing database, pediatric (age <18 years) heart transplant candidates were divided into lower quartile, interquartile, and upper quartile categories based on final maximum acceptable donor-candidate weight ratio (DCW), expressed as percentage. Baseline characteristics and waitlist outcomes, including monthly offers/candidate and survival were compared.
Overall median DCW was 200% (range, 159%-241%). Patients with congenital heart disease had higher DCW than those with cardiomyopathy (223% vs 203%; P < .001). Number of monthly offers/candidate (5.0, 5.6, and 7.2, respectively; P < .001) increased with quartile of DCW. Posttransplant survival was similar amongst the groups (log-rank P > .05). Subgroup analysis of critically ill children showed a waitlist survival advantage in those listed with a DCW ≥200% (P < .001).
Despite substantial practice variation in acceptable donor weight in pediatric heart transplantation, patients listed with variable DCW had similar posttransplant survival. However, in critically ill patients, higher DCW was associated with greater waitlist survival. Better understanding of the importance of donor weight could reduce practice variability and improve organ use and waitlist outcomes for pediatric cardiac transplant candidates.
通过其他身体参数准确预测心脏大小一直是一个难题，因为这决定了一个供体心脏是否适合某个等待名单上的候选人，但每年都有数百个供体因大小不匹配而被拒绝。
我们旨在描述目前在心脏移植中如何利用供体体重参数及其对等待名单结果的影响。
从美国器官共享网络数据库中，根据最终可接受的供体-受者体重比（DCW）的下四分位数、四分位数间距和上四分位数，将儿科（年龄<18 岁）心脏移植候选者分为下四分位数、四分位数间距和上四分位数组，以百分比表示。比较基线特征和等待名单结果，包括每月的供体/候选者数量和生存率。
总体中位数 DCW 为 200%（范围，159%-241%）。与心肌病患者相比，患有先天性心脏病的患者具有更高的 DCW（223%比 203%；P<.001）。每月的供体/候选者数量（分别为 5.0、5.6 和 7.2；P<.001）随着 DCW 四分位的增加而增加。各组之间的移植后生存率相似（对数秩 P>.05）。危重症儿童的亚组分析显示，在 DCW≥200%的患者中，等待名单上的生存率具有优势（P<.001）。
尽管在儿科心脏移植中接受供体体重存在很大的实践差异，但具有不同 DCW 的患者在移植后具有相似的生存率。然而，在危重症患者中，较高的 DCW 与更大的等待名单生存率相关。更好地了解供体体重的重要性可以减少实践差异，提高儿科心脏移植候选者的器官使用和等待名单结果。
