Heart failure & cardiomyopathiesCohort study
Assessing Donor-Recipient Size Mismatch in Pediatric Heart Transplantation
- Retrospective cohort study
- registry (Pediatric Heart Transplant Society database)
Authors' conclusion
In pediatric HT, D-R appear most optimally matched using TCV. Only D-R size mismatch by TCV and height independently predicts graft survival.
Study context
- Population
- Donor-recipient pairs undergoing pediatric heart transplantation, Pediatric Heart Transplant Society database, 1993–2021
- Participants
- 7,715 donor-recipient (D-R) pairs
- Exposure
- Donor-recipient size mismatch metrics and graft survival
- Outcome
- Graft survival
- Follow-up
- 1 and 5 years
Main finding
As reported in the abstract
Graft survival by size mismatch metric
- Only D-R mismatch by height and total cardiac volume (TCV) predicted graft survival
- Effects of size mismatch on graft survival nonlinear
- Undersizing and oversizing by height increased graft loss, more frequently with undersizing
- TCV: minimal donor undersizing protective; oversizing up to 25% not associated with increased graft loss
Observational data: associations, not effects.
Further findings
Well matched (D-R ratio −20% to +20%), by metric
- Weight
- 36.0%
- Predicted heart mass
- 39.0%
- Body surface area
- 50.0%
- BMI
- 57.0%
- Height
- 71.0%
- TCV
- 93.0%
Rejection with moderately undersized donors by height (D-R ratio <−30%)
- Frequent rejection post-HT
- P < 0.001
Original publication
Assessing Donor-Recipient Size Mismatch in Pediatric Heart Transplantation. JACC Heart Fail. Published 6 September 2023. doi:10.1016/j.jchf.2023.07.005
Summarised from the published abstract; every number is checked against it