Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California.
Department of Statistics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, California.
Ann Thorac Surg. 2023 Dec;116(6):1241-1248. doi: 10.1016/j.athoracsur.2022.05.067. Epub 2022 Jul 11.
Infants account for a significant proportion of pediatric heart transplantation but also suffer from a high waitlist mortality. Donor oversizing by weight-based criteria is common practice in transplantation and is prevalent in this group. We sought to analyze the impact of oversizing on outcomes in infants.
Infant heart transplantations reported to the United Network for Organ Sharing from January 1994 to September 2019 were retrospectively analyzed. 2384 heart transplantation recipients were divided into quintiles (Q1-Q5) on the basis of donor-to-recipient weight ratio (DRWR). Multivariate Cox regression was used to estimate the effect of DRWR. The primary end point was graft survival at 1 year.
The median DRWR for each quintile was 0.90 (0.37-1.04), 1.17 (1.04-1.29), 1.43 (1.29-1.57), 1.74 (1.58-1.97), and 2.28 (1.97-5.00). Pairwise comparisons showed improved survival for Q3 and Q4 over each of the bottom 2 quintiles and the top quintile. Regression analyses found that Q3 and Q4 were protective against graft failure compared with the bottom 2 quintiles. There was no difference in hazard among the top 3 quintiles. Significant covariates included primary diagnosis, ischemia time, serum bilirubin level, transplantation year, mechanical ventilation at transplantation, and extracorporeal membrane oxygenation at transplantation. Sex, female-to-male transplantation, and mechanical circulatory support at transplantation were not significant in univariate analyses.
Modest oversizing by DRWR (1.29-1.97) is associated with increased survival and lower risk in infant heart transplantation. Additional investigation is needed to establish best practices for size matching in this population.
婴儿在儿科心脏移植中占很大比例，但也有很高的等待名单死亡率。根据体重标准对供体进行过大估计是移植中的常见做法，在这一群体中也很普遍。我们试图分析供体与受体体重比（DRWR）过大对婴儿结局的影响。
回顾性分析了 1994 年 1 月至 2019 年 9 月期间向器官共享联合网络报告的婴儿心脏移植病例。根据供体与受体体重比，将 2384 例心脏移植受者分为五组（Q1-Q5）。使用多变量 Cox 回归来估计 DRWR 的影响。主要终点是 1 年时移植物存活率。
每组的中位数 DRWR 分别为 0.90（0.37-1.04）、1.17（1.04-1.29）、1.43（1.29-1.57）、1.74（1.58-1.97）和 2.28（1.97-5.00）。两两比较显示，Q3 和 Q4 与每组的后 2 组相比，生存率提高。回归分析发现，与后 2 组相比，Q3 和 Q4 对移植物衰竭有保护作用。前 3 组之间的危险无差异。显著的协变量包括主要诊断、缺血时间、血清胆红素水平、移植年份、移植时机械通气和移植时体外膜氧合。在单变量分析中，性别、女性对男性移植和移植时机械循环支持均无显著意义。
DRWR（1.29-1.97）适度增大与婴儿心脏移植存活率增加和风险降低相关。需要进一步研究以确定该人群中最佳的大小匹配实践。
