Division of Cardiovascular and Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Ann Thorac Surg. 2021 Apr;111(4):1299-1307. doi: 10.1016/j.athoracsur.2020.06.109. Epub 2020 Sep 11.
Heart transplantation is limited by the supply of donor organs. Previous studies have associated female donor to male recipient with decreased posttransplant survival. We wanted to evaluate whether this risk can be mitigated using higher donor than recipient body mass index (BMI).
We performed a retrospective analysis of the Organ Procurement and Transplantation Network/United Network of Organ Sharing registry encompassing years 2005 to 2018 for all male adult recipients (>18 years of age) who underwent isolated heart transplantation with grafts from female donors. The association between donor and recipient BMI difference and recipient survival was evaluated using adjusted Cox proportional hazards modeling.
A total of 3788 male recipients who received female donor hearts met inclusion criteria for analysis. Maximally selected rank statistics identified donor minus recipient BMI of 1.5 kg/m as a meaningful cutoff point in the analysis of recipient survival. Multivariable Cox proportional hazards analysis demonstrated that increasing donor BMI relative to recipient BMI up to this cutoff point was associated with improved survival (hazard ratio per 5-unit difference, 0.87; 95% confidence interval, 0.77-0.99). Above this cutoff point, increasing donor BMI relative to the recipient did not improve survival more than what was achieved by adding 1.5 of BMI difference (hazard ratio per 5-unit difference, 0.97; 95% confidence interval, 0.90-1.04).
Increasing donor BMI relative to recipient BMI up to 1.5 kg/m greater than recipient BMI was associated with improved survival. BMI difference may be useful as a simple surrogate for predicted heart mass difference to help mitigate the impact of sex mismatch in heart transplantation.
心脏移植受到供体器官供应的限制。先前的研究表明，女性供体与男性受者的移植后存活率降低有关。我们想评估使用更高的供体与受者体重指数（BMI）差值是否可以降低这种风险。
我们对 2005 年至 2018 年期间器官获取与移植网络/联合器官共享网络的登记数据进行了回顾性分析，纳入所有接受女性供体心脏移植的成年男性受者（年龄>18 岁）。使用调整后的 Cox 比例风险模型评估供体与受者 BMI 差值与受者存活率之间的关系。
共有 3788 名接受女性供体心脏的男性受者符合分析纳入标准。最大选择秩统计确定供体与受者 BMI 的差值为 1.5kg/m 是受者存活率分析的一个有意义的切点。多变量 Cox 比例风险分析表明，在该切点之前，供体 BMI 相对于受者 BMI 每增加 5 个单位，存活率就会提高（每增加 5 个单位的 HR，0.87；95%置信区间，0.77-0.99）。在此切点之上，供体 BMI 相对于受者 BMI 的增加并不能改善超过增加 1.5 个 BMI 差值所带来的生存获益（每增加 5 个单位的 HR，0.97；95%置信区间，0.90-1.04）。
供体 BMI 相对于受者 BMI 增加 1.5kg/m 以上与存活率提高相关。BMI 差值可能是预测心脏质量差异的简单替代指标，有助于减轻心脏移植中性别不匹配的影响。
