Korean J Transplant.  2022 Nov;36(Supple 1):S251. 10.4285/ATW2022.F-3919.

The impact of oversized donor matching on clinical outcomes after heart transplantation

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

Background
Adequate cardiac allograft sizing is one of the main considerations in heart transplantation. Although several studies report the use of undersized hearts and its impact on post-heart transplant outcomes, compelling evidence regarding the use of oversized hearts is lacking.
Methods
We identified patients who underwent orthotopic heart transplantation at our institution from November 1992 to September 2020. Patients were categorized based on donor-recipient predicted heart mass (PHM) matched or oversized matched (>30%). The effect of the use of an oversized heart on clinical outcomes was investigated.
Results
Of a total of 485 patients, 108 (22.3%) patients received an oversized heart. During follow-up (median, 78.8; postoper-ative months interquartile range, 39.7–119.4 months), death occurred in 116 patients (3.57/patient-year). In multivariable analy-sis, diabetes mellitus (hazard ratio [HR], 2.25; 95% confidence interval [CI], 1.47–3.44; P<0.001), dialysis (HR, 2.04; 95% CI, 1.05– 3.99; P=0.04), preoperative mechanical cardiac support (HR, 2.14; 95% CI, 1.35–3.38; P=0.001) were independent predictors of death. After adjustment for such predictors, spline curves showed that PHM oversized donor was not associated with death (Fig.1). As size-matched recipients, recipients of oversized hearts showed similar mortality (5 years; 82.8% vs. 82.3%, P=0.6).
Conclusions
Utilizing predictive heart mass oversized donors may not be associated with a detriment in survival.

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