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. 2022 Aug;36(8):e14744.
doi: 10.1111/ctr.14744. Epub 2022 Jul 8.

Predicted heart mass for size matching in obese heart transplant donors and recipients

Natasha Aleksova  1 , Chun-Po S Fan  2 , Farid Foroutan  2 , Yas Moayedi  1 , Juan Duero Posada  1 , Caroline McGuinty  3 , Adriana Luk  1 , Josef Stehlik  4 , Heather J Ross  1 , Ana C Alba  1
Affiliations

Predicted heart mass for size matching in obese heart transplant donors and recipients

Natasha Aleksova et al. Clin Transplant. 2022 Aug.

Abstract

Introduction: Predicted heart mass (PHM) was neither derived nor evaluated in an obese population. Our objective was to evaluate size mismatch using actual body weight or ideal body weight (IBW)-adjusted PHM on mortality and risk assessment.

Methods: We conducted a retrospective cohort study of adult recipients with BMI ≥30 kg/m2 or recipients of donors with BMI≥30 kg/m2 from the ISHLT registry. We used multivariable Cox proportional hazard models to evaluate 30-day and 1-year mortality. The two models were compared using net reclassification index.

Results: 10,817 HT recipients, age 55 (IQR 46-62) years, 23% female, BMI 31 kg/m2 (IQR 28-33) were included. Donors were age 34 (IQR 24-44) years, 31% female, and BMI 31 kg/m2 (IQR 26-34). There was a significant nonlinear association between mortality and actual PHM but not IBW-adjusted PHM. Undersizing using actual PHM was associated with higher 30-day and 1-year mortality (p < .01), not seen with IBW-adjusted PHM. Actual PHM better risk classified .6% (95% CI .3-.8) patients compared to IBW-adjusted PHM.

Conclusion: Actual PHM can be used for size matching when assessing mortality risk in obese recipients or recipients of obese donors. There is no advantage to re-calculating PHM using IBW to define candidate risk at the time of organ allocation.

Keywords: clinical decision-making; obesity; organ acceptance; organ allocation; registry analysis.

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References

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