Division of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada.
Department of Clinical Physiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Semin Thorac Cardiovasc Surg. 2022 Spring;34(1):158-167. doi: 10.1053/j.semtcvs.2021.01.001. Epub 2021 Jan 12.
Donor and recipient size matching during heart transplant can be assessed using weight or predicted heart mass (PHM) ratios. We developed sex-specific allomteric equations for PHM and predicted lean body mass (PLBM) using the United Kingdom Biobank (UKB) and evaluated their predictive value in the United Network of Organ Sharing database. Donor and recipient size matching was based on weight, PHM and PLBM ratios. PHM was calculated using the Multiethnic Study of Atherosclerosis and UKB equations. PLBM was calculated using the UKB and National Health and Nutrition Examination Survey equations. Relative prognostic utility was compared using multivariable Cox analysis, adjusted for predictors of 1-year survival in the Scientific Registry of Transplant Recipients model. Of 53,648 adult patients in the United Network of Organ Sharing database between 1996 and 2016, 6528 (12.2%) died within the first year. In multivariable analysis, undersized matches by any metric were associated with increased 1-year mortality (all P < 0.01). Oversized matches were at increased risk using PHM or PLBM (all P < 0.01), but not weight ratio. There were significant differences in classification of size matching by weight or PHM in sex-mismatched donor-recipient pairs. A significant interaction was observed between pulmonary hypertension and donor undersizing (hazard ratio 1.15, P = 0.026) suggesting increased risk of undersizing in pulmonary hypertension. Donor and recipient size matching with simplified PHM and PLBM offered an advantage over total body weight and may be more important for sex-mismatched donor-recipient pairs. Donor undersizing is associated with worse outcomes in patients with pulmonary hypertension.
在心脏移植中，可以使用体重或预测的心脏质量（PHM）比值来评估供体和受体的大小匹配。我们使用英国生物库（UKB）开发了 PHM 和预测瘦体重（PLBM）的性别特异性异体方程，并在器官共享联合网络数据库中评估了它们的预测价值。供体和受体的大小匹配基于体重、PHM 和 PLBM 比值。PHM 使用多民族动脉粥样硬化研究和 UKB 方程计算。PLBM 使用 UKB 和国家健康和营养检查调查方程计算。使用多变量 Cox 分析比较相对预后效用，调整了 Scientific Registry of Transplant Recipients 模型中 1 年生存率的预测因素。在 1996 年至 2016 年期间，器官共享联合网络数据库中的 53648 名成年患者中，有 6528 名（12.2%）在 1 年内死亡。在多变量分析中，任何指标的大小不匹配都与 1 年死亡率增加相关（均 P < 0.01）。使用 PHM 或 PLBM，大小不匹配的供体与受体风险增加（均 P < 0.01），但体重比值则不然。在性别不匹配的供体-受体对中，体重或 PHM 分类的大小匹配存在显著差异。观察到肺动脉高压和供体尺寸不足之间存在显著的相互作用（危险比 1.15，P=0.026），表明肺动脉高压患者的尺寸不足风险增加。使用简化的 PHM 和 PLBM 进行供体和受体的大小匹配比使用总体重具有优势，对于性别不匹配的供体-受体对可能更为重要。在肺动脉高压患者中，供体尺寸不足与预后较差相关。
