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.
J Heart Lung Transplant. 2022 Dec;41(12):1790-1797. doi: 10.1016/j.healun.2022.08.027. Epub 2022 Sep 8.
Predicted Heart Mass (PHM) has emerged as an attractive size matching metric in adult cardiac transplantation. However, since PHM was derived from a healthy adult cohort, its generalizability to the pediatric population is unclear. We hypothesize that PHM can be extended to older adolescents, and potentially broaden the donor pool available to this group.
The United Network for Organ Sharing database was retrospectively analyzed for patients aged 13 to 18 undergoing heart transplantation. Recipients were divided into quintiles (Q1-Q5) based on donor-to-recipient predicted heart mass ratios (PHMR). Primary end-point was graft survival at 5 years.
Two thousand sixty-one adolescent heart transplant recipients between January 1994 and September 2019 were retrospectively analyzed. The median PHMR's for each quintile was 0.84 (0.59-0.92), 0.97 (0.92-1.02), 1.08 (1.02-1.14), 1.21 (1.14-1.30), and 1.44 (1.30-2.31). Kaplan-Meier survival curves demonstrated comparable survival across all quintiles of PHMR (p = 0.9). Multivariate Cox regression showed no significant difference in graft failure of the outer quintiles when compared to the middle quintile (Q1: 1.04 HR, p = 0.80; Q2: 1.02 HR, p = 0.89; Q4: 1.19 HR, p = 0.28; Q5: 1.02 HR, p = 0.89). Significant covariates included transplant year (HR: 0.95, p < 0.0001), serum bilirubin (HR: 1.04, p = 0.0004), ECMO at transplantation (HR: 2.85, p < 0.0001), and underlying diagnosis of dilated cardiomyopathy (vs congenital heart disease, HR: 0.66, p = 0.0004).
Matching by PHM is not associated with survival or risk in adolescent heart transplant recipients. Our results underscore the ongoing need to develop an improved size-matching method in pediatric heart transplantation.
在成人心脏移植中，预测心脏质量（PHM）已成为一种有吸引力的大小匹配指标。然而，由于 PHM 是从健康成年人队列中得出的，因此其在儿科人群中的通用性尚不清楚。我们假设 PHM 可以扩展到年龄较大的青少年，并有可能扩大该人群的供体池。
回顾性分析了 1994 年 1 月至 2019 年 9 月期间接受心脏移植的年龄在 13 至 18 岁的患者的美国器官共享网络数据库。根据供体与受体的预测心脏质量比（PHMR），将受者分为五分位数（Q1-Q5）。主要终点是 5 年时的移植物存活率。
回顾性分析了 2061 名 1994 年 1 月至 2019 年 9 月期间接受心脏移植的青少年患者。每个五分位数的中位 PHMR 分别为 0.84（0.59-0.92）、0.97（0.92-1.02）、1.08（1.02-1.14）、1.21（1.14-1.30）和 1.44（1.30-2.31）。Kaplan-Meier 生存曲线表明，在所有 PHMR 五分位数中，生存率相当（p=0.9）。多变量 Cox 回归显示，与中间五分位数相比，外五分位数的移植物衰竭无显著差异（Q1：1.04 HR，p=0.80；Q2：1.02 HR，p=0.89；Q4：1.19 HR，p=0.28；Q5：1.02 HR，p=0.89）。显著的协变量包括移植年份（HR：0.95，p<0.0001）、血清胆红素（HR：1.04，p=0.0004）、移植时的体外膜肺氧合（HR：2.85，p<0.0001）和基础诊断为扩张型心肌病（与先天性心脏病相比，HR：0.66，p=0.0004）。
PHM 匹配与青少年心脏移植受者的存活率或风险无关。我们的结果强调了在儿科心脏移植中需要不断开发改进的大小匹配方法。
