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. 2023 Dec;116(6):1241-1248.
doi: 10.1016/j.athoracsur.2022.05.067. Epub 2022 Jul 11.

Weight Matching in Infant Heart Transplantation: A National Registry Analysis

James Y Lee  1 , Sumanth Kidambi  1 , Roy S Zawadzki  2 , David N Rosenthal  3 , John C Dykes  3 , Teimour Nasirov  1 , Michael Ma  4
Affiliations

Weight Matching in Infant Heart Transplantation: A National Registry Analysis

James Y Lee et al. Ann Thorac Surg. 2023 Dec.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Figures

Figure 1:
Figure 1:
Distribution of donor-recipient weight ratios in 2384 infants transplanted from 1994 to 2019
Figure 2:
Figure 2:
Kaplan-Meier survival curves stratified by donor-recipient weight ratio (DRWR) quintiles. Pairwise comparisons of survival curves are made using the log-rank test with Benjamini-Hochberg correction
See this image and copyright information in PMC

Comment in

  • Waiting for the Perfect Match.
    Overman DM, MacIver R. Overman DM, et al. Ann Thorac Surg. 2023 Dec;116(6):1248-1249. doi: 10.1016/j.athoracsur.2022.07.024. Epub 2022 Jul 31. Ann Thorac Surg. 2023. PMID: 35921859 No abstract available.

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