Department of Cardiology, Boston Children's Hospital, Boston, MA, United States.
Department of Pediatrics, Harvard Medical School, Boston, MA, United States.
Transpl Int. 2022 Feb 7;35:10226. doi: 10.3389/ti.2022.10226. eCollection 2022.
Previous analyses in pediatric heart transplant (HT) recipients using weight or height have not found donor-recipient size-mismatch to be associated with post-transplant mortality. A recent study in 3,215 normal US children developed an equation for left ventricular (LV) mass using body surface area (BSA). We assessed whether donor-recipient size match using predicted LV mass (PLM) is associated with post-transplant in-hospital mortality or 1-year graft survival. We identified 4,717 children 18 yrs old who received primary HT in the US during 01/2000 to 03/2015 and divided them into five groups [10%, 10%, 60% (reference group), 10% and 10%, respectively] with increasing donor-recipient PLM ratio. In adjusted analysis, group 1 children (PLM ratio ≤.90) were at higher risk of post-transplant in-hospital mortality [Odds Ratio (OR) 1.55, 95% CI 1.04, 2.31]. This association of the most undersized donors with recipient in-hospital mortality was similar when donor-recipient weight ratio<.88 or BSA ratio<.92 (lowest decile) were used instead. There was no difference in 1-year graft survival among groups. Utilizing donors with donor-recipient PLM ratio ≤.90 is associated with higher risk of early post-transplant mortality in pediatric HT recipients. However, this metric is not superior to donor-recipient weight ratio or BSA ratio for assessing size match.
此前，使用体重或身高分析儿科心脏移植（HT）受者的研究发现，供受者大小不匹配与移植后死亡率无关。最近一项针对 3215 名美国正常儿童的研究使用体表面积（BSA）开发了左心室（LV）质量的方程。我们评估了使用预测 LV 质量（PLM）的供受者大小匹配是否与移植后住院期间死亡率或 1 年移植物存活率相关。我们确定了 1980 年至 2015 年期间在美国接受初次 HT 的 4717 名 18 岁儿童，并将他们分为五组[分别为 10%、10%、60%（参考组）、10%和 10%]，供受者 PLM 比值逐渐增加。在调整分析中，第 1 组（PLM 比值≤.90）的儿童在移植后住院期间死亡的风险较高[比值比（OR）为 1.55，95%置信区间为 1.04 至 2.31]。当使用供受者体重比值<.88 或 BSA 比值<.92（最低十分位数）代替时，这种最小供体与受者住院期间死亡率之间的关联是相似的。各组之间 1 年移植物存活率没有差异。使用供受者 PLM 比值≤.90 的供体与儿科 HT 受者早期移植后死亡率升高相关。然而，该指标在评估大小匹配方面并不优于供受者体重比值或 BSA 比值。
