Size matching in combined heart-lung transplant: An undersized predicted heart mass is associated with increased mortality.
graft rejection
heart transplantation
heart-lung transplantation
lung transplantation
size matching
Journal
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
ISSN: 1557-3117
Titre abrégé: J Heart Lung Transplant
Pays: United States
ID NLM: 9102703
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
29
12
2021
revised:
25
02
2022
accepted:
18
03
2022
pubmed:
23
4
2022
medline:
30
6
2022
entrez:
22
4
2022
Statut:
ppublish
Résumé
Numerous studies have analyzed the consequences of donor-recipient organ size mismatch within both heart and lung transplantation. However, there is very little data on size matching in combined heart-lung transplantation (HLTx). We reviewed how donor/recipient predicted total lung capacity (pTLC), predicted heart mass (pHM), weight, and height ratios affect HLTx survival and graft rejection outcome. We performed a retrospective analysis on adult HLTx patients using the UNOS database. Overall survival at 1- and 5-years, as well as 5-years bronchiolitis obliterans syndrome (BOS) and coronary artery vasculopathy (CAV) development, were the outcomes of interest. Each sizing modality was split into 5 groups for survival analysis and 3 groups for graft rejection analysis based on an approximately equal size-matched reference group. In total, 747 patients were analyzed in our study. Of the 4 sizing modalities, only pHM ratio had a significant difference in acute and long-term survival. In particular, a severely undersized pHMr of < 83% was associated with an increased risk of mortality compared to an approximately equally sized match (1-year: HR=1.95, 95% CI=1.30-2.91, p = 0.001; 5-year: HR = 1.47, 95% CI = 1.05-2.06, p = 0.027). No sizing metric was predictive of BOS or CAV development. Our analysis supports the use of pHM ratio for size matching in HLTx. Based on our results, a donor/recipient pHM ratio of >83% should be achieved to minimize mortality risk associated with sizing mismatch.
Sections du résumé
BACKGROUND
Numerous studies have analyzed the consequences of donor-recipient organ size mismatch within both heart and lung transplantation. However, there is very little data on size matching in combined heart-lung transplantation (HLTx). We reviewed how donor/recipient predicted total lung capacity (pTLC), predicted heart mass (pHM), weight, and height ratios affect HLTx survival and graft rejection outcome.
METHODS
We performed a retrospective analysis on adult HLTx patients using the UNOS database. Overall survival at 1- and 5-years, as well as 5-years bronchiolitis obliterans syndrome (BOS) and coronary artery vasculopathy (CAV) development, were the outcomes of interest. Each sizing modality was split into 5 groups for survival analysis and 3 groups for graft rejection analysis based on an approximately equal size-matched reference group.
RESULTS
In total, 747 patients were analyzed in our study. Of the 4 sizing modalities, only pHM ratio had a significant difference in acute and long-term survival. In particular, a severely undersized pHMr of < 83% was associated with an increased risk of mortality compared to an approximately equally sized match (1-year: HR=1.95, 95% CI=1.30-2.91, p = 0.001; 5-year: HR = 1.47, 95% CI = 1.05-2.06, p = 0.027). No sizing metric was predictive of BOS or CAV development.
CONCLUSION
Our analysis supports the use of pHM ratio for size matching in HLTx. Based on our results, a donor/recipient pHM ratio of >83% should be achieved to minimize mortality risk associated with sizing mismatch.
Identifiants
pubmed: 35450737
pii: S1053-2498(22)01885-X
doi: 10.1016/j.healun.2022.03.013
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
961-970Informations de copyright
Copyright © 2022 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure statement Yoshiya Toyoda – Clinical research and grant support from Transmedics Incorporated, Cerus Corporation ReciPe Study, and EvaHeart Incorporated. This had no relationship with the current study and has not affected the integrity of our report. The authors have no conflicts of interest to declare.