Assessing predicted heart mass size matching in obese heart transplant recipients.
Publication/Presentation Date
8-1-2021
Abstract
BACKGROUND: Predicted heart mass (PHM) is currently the most reliable metric for donor-recipient size matching in heart transplantation. Undersizing PHM donor-recipient match more than 20% independently predicts reduced survival. However, it is unclear if this is the case in obese recipients, in whom size matching can be challenging. We examined the use of PHM undersized hearts in obese recipients and assessed its impact on survival.
METHODS: The United Network for Organ Sharing database was queried for adult patients undergoing heart transplantation from 1995 to 2020. Obese recipients (BMI ≥ 30) were categorized based on donor-recipient PHM match ≤-20% (undersized) or >-20% (size-matched). Nearest-neighbor propensity score matching was performed to adjust for baseline differences between cohorts. Temporal outcomes were compared by Kaplan-Meier survival analysis.
RESULTS: A total of 13,668 obese recipients met inclusion criteria, with 9.6% receiving undersized and 90.4% receiving size-matched hearts. The proportion of undersized donor hearts in obese recipients significantly decreased over the study period (16.2% [1995] to 7.4% [2019], NP-trend < 0.001). Propensity-score matching resulted in 984 well-matched pairs of undersized and size-matched obese recipients. Recipients of undersized hearts saw similar 30-day mortality (5.5% vs 6.0%, p= 0.11) and re-transplantation rates (1.2% vs 1.2%, p = 1.00) as size-matched recipients. Survival at 1 year (88.4% vs 87.9%, p = 0.14), and 15 years (35.1% vs 31.0%, p = 0.12) was similar across cohorts.
CONCLUSIONS: A decreasing proportion of PHM undersized hearts are being utilized in obese recipients. However, utilizing PHM undersized hearts in obese recipients was not associated with a detriment in survival.
Volume
40
Issue
8
First Page
805
Last Page
813
ISSN
1557-3117
Published In/Presented At
Kim, S. T., Helmers, M. R., Iyengar, A., Smood, B., Herbst, D. A., Patrick, W. L., Han, J. J., Altshuler, P., & Atluri, P. (2021). Assessing predicted heart mass size matching in obese heart transplant recipients. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 40(8), 805–813. https://doi.org/10.1016/j.healun.2021.04.020
Disciplines
Medicine and Health Sciences
PubMedID
34127356
Department(s)
Department of Surgery
Document Type
Article