Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois.
Department of Medicine, Division of Cardiology, University of California, Los Angeles, Los Angeles, California.
J Heart Lung Transplant. 2019 Nov;38(11):1197-1205. doi: 10.1016/j.healun.2019.08.020. Epub 2019 Aug 24.
The heart transplant (HT) guidelines recommendation to match recipient and donors within 30% of body weight lacks a strong evidence base and is not well established in patients bridged to transplant with left ventricular assist devices (LVAD). In light of the scarcity of donor hearts, we investigated the effect of size mismatch on hemodynamics, one-year survival and length of stay (LOS) following HT.
Single-center retrospective analysis of consecutive HT patients from April 2007 to September 2017. Recipients were divided into 3 cohorts based on donor-to-recipient weight ratio (DRWR): (1) undersized (<0.7), (2) size-matched, (0.7-1.3); (3) oversized (>1.3).
288 consecutive patients were identified (mean age 53 ± 11 years; 76% male), 46 were undersized (0.61 ± 0.05), 210 size-matched (0.94 ± 0.16), and 32 oversized (1.65 ± 0.38). There was no significant difference in donor left ventricular end diastolic diameter (LVEDD) between the 3 groups (p = 0.11). The donor/recipient (D/R) predicted heart mass (PHM) was lowest in the undersized group (0.92 ± 0.13). There were no significant differences in 1-year survival in the overall and LVAD cohort (p = 0.65 and 0.59, respectively). Neither donor LVEDD nor D/R PHM differed among survivors or non-survivors. LOS was longer in the undersized group than the size-matched cohort (p = 0.004). The undersized group had hearts with the highest filling pressures and lowest cardiac index at 1 week among the remaining groups (p = 0.009, 0.017, and p = 0.05, respectively). There were no clinically significant differences in hemodynamics at 1 or 6 months.
HT undersizing affects hemodynamics early but not later in the course and does not impact 1-year survival. The liberalization of size matching may increase the HT donor pool significantly.
心脏移植（HT）指南推荐在 30%的体重范围内匹配受者和供者，这一建议缺乏强有力的证据支持，并且在使用左心室辅助装置（LVAD）桥接移植的患者中尚未得到很好的确定。鉴于供心的稀缺性，我们研究了大小不匹配对 HT 后血流动力学、一年生存率和住院时间（LOS）的影响。
对 2007 年 4 月至 2017 年 9 月期间连续进行的 HT 患者进行单中心回顾性分析。根据供受者体重比（DRWR）将受者分为 3 组：（1）供体小于受者（<0.7）；（2）供体与受者匹配（0.7-1.3）；（3）供体大于受者（>1.3）。
共确定了 288 例连续患者（平均年龄 53 ± 11 岁；76%为男性），其中 46 例供体小于受者（0.61 ± 0.05），210 例供体与受者匹配（0.94 ± 0.16），32 例供体大于受者（1.65 ± 0.38）。3 组间供体左心室舒张末期直径（LVEDD）无显著差异（p=0.11）。供体/受体（D/R）预测心脏质量（PHM）在供体小于受者组最低（0.92 ± 0.13）。在整体和 LVAD 队列中，1 年生存率无显著差异（p=0.65 和 0.59）。幸存者和非幸存者之间的供体 LVEDD 或 D/R PHM 没有差异。与匹配组相比，供体小于受者组的 LOS 更长（p=0.004）。在其余组中，供体小于受者组在第 1 周时具有最高的充盈压和最低的心输出量（p=0.009、0.017 和 p=0.05）。在 1 个月和 6 个月时，血流动力学均无明显差异。
HT 供体小于受者会影响早期但不影响后期的血流动力学，并且不影响 1 年生存率。放宽大小匹配可能会显著增加 HT 供体库。
