Predicted heart mass is the optimal metric for size match in heart transplantation
Predicted heart mass is the optimal metric for size match in heart transplantation
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DOI：
10.1016/j.healun.2018.09.017
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发表时间：
2019-02-01
影响因子：
8.9
通讯作者：
Kobashigawa, Jon A.
中科院分区：
文献类型：
--
作者：
Kransdorf, Evan P.;Kittleson, Michelle M.;Kobashigawa, Jon A.
背景：传统上通过体重来评估供体-受体大小匹配。我们评估了5个尺寸匹配指标-预测心脏质量（PHM）、体重、身高、体重指数（BMI）和体表面积（BSA）-预测心脏移植后1年死亡率的能力，并评估了尺寸匹配对供体心脏因尺寸而降低的影响。该研究队列包括2007年至2016年期间联合器官共享网络登记处的19，168名成人心脏移植受者。使用每个度量的供体-受体比率将每个大小匹配度量分为7个相等大小的组。结果：在严重（供受者PHM比0.54-0.86）小于PHM组中，受者的死亡率增加，危险比为1.34（95%置信区间，1.13-1.59; p < 0.001）。如果供体的体重、身高、BMI或BSA偏小，则1年时死亡风险不会增加。我们发现，32%的心脏提供拒绝捐助者的大小将是可以接受的使用PHM阈值为0.86或更高，14%的报价接受（其中大部分是女性捐助者对男性收件人）低于此threshold.CONCLUSIONS：PHM是最佳的捐助者-受体大小匹配度量心脏移植后死亡率的预测。许多因供体大小而被拒绝的供体超过了PHM确定的大小匹配的阈值，因此，使用PHM可以提高供体心脏的利用率和移植后生存率。(C)2018年国际心肺移植学会。All rights reserved.
BACKGROUND: Donor-recipient size match is traditionally assessed by body weight. We assessed the ability of 5 size match metrics-predicted heart mass (PHM), weight, height, body mass index (BMI) and body surface area (BSA)-to predict 1-year mortality after heart transplant and to assess the effect of size match on donor heart turn down for size.METHODS: The study cohort comprised 19,168 adult heart transplant recipients in the United Network for Organ Sharing registry between 2007 and 2016. Each size match metric was divided into 7 equally sized groups using the donor-recipient ratio for each metric. Single and multivariable Cox proportional hazard models for mortality 1 year after transplant were constructed.RESULTS: Recipients in the severely (donor-recipient PHM ratio 0.54-0.86) undersized group for PHM experienced increased mortality, with a hazard ratio of 1.34 (95% confidence interval, 1.13-1.59; p < 0.001). There was no increased risk of death at 1 year if donors were undersized for weight, height, BMI, or BSA. We found that 32% of heart offers turned down for donor size would be acceptable using a PHM threshold of 0.86 or greater and that 14% of offers accepted (most of which are female donor to male recipient) were below this threshold.CONCLUSIONS: PHM is the optimal donor-recipient size match metric for prediction of mortality after heart transplant. Many offers turned down for donor size were above the threshold for adequacy of size match by PHM identified, and thus, the use of PHM could improve donor heart utilization and posttransplant survival. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.