Impact of donor-to-recipient weight ratio on survival after heart transplantation: analysis of the United Network for Organ Sharing Database.
BACKGROUND
Generally accepted donor criteria for heart transplantation limit allografts from donors within approximately 20% to 30% of the recipient's weight. We analyzed the impact of donor-to-recipient weight ratio on survival after heart transplantation.


RESULTS
Adult heart transplant recipients reported to the United Network for Organ Sharing from 1999 to 2007 were divided into 3 groups based on donor-to-recipient weight ratio: <0.8, 0.8 to 1.2, and >1.2. Kaplan-Meier methodology was used to estimate survival. Propensity-adjusted Cox regression modeling was used to analyze predictors of mortality. A total of 15 284 heart transplant recipients were analyzed; 2078 had weight ratio of <0.8, 9684 had 0.8 to 1.2, and 3522 had >1.2. Kaplan-Meier survival was not statistically different between groups at 5 years (P=0.26). Among patients with weight ratio <0.8, 5-year survival was lower for recipients with high pulmonary vascular resistance (>4 Woods units; P=0.02). Among recipients with high pulmonary vascular resistance, 5-year survival was similar for those with weight ratio 0.8 to 1.2 and >1.2 (P=0.44). Furthermore, male recipients with elevated pulmonary vascular resistance who received hearts from female donors had a significantly worse survival than males who received hearts from male donors (P=0.01). Propensity-adjusted multivariable analysis demonstrated that weight ratio <0.8 did not predict mortality (hazard ratio, 1.09; 95% CI, 0.94 to 1.27; P=0.21). Five-year survival after propensity matching was not statistically different between those with weight ratio <0.8 versus >/=0.8 (P=0.37).


CONCLUSIONS
Weight ratio did not predict mortality after heart transplantation. However, recipients with elevated pulmonary vascular resistance who received undersized hearts had poor survival. Furthermore, in the setting of high pulmonary vascular resistance, male recipients who received hearts from female donors had worse survival than those who received hearts from male donors. Extending donor criteria to include undersized hearts in select recipients should be considered.
Patel
Nishant D
ND
Associate Professor of Surgery, Associate Chief of Cardiac Surgery, Chief of Heart and Lung Transplantation, 600 North Wolfe Street/Blalock 618, Baltimore, MD 21287, USA.
Weiss
Eric S
ES
Nwakanma
Lois U
LU
Russell
Stuart D
SD
Baumgartner
William A
WA
Shah
Ashish S
AS
Conte
John V
JV
D001835:Body Weight; D016208:Databases, Factual; D005260:Female; D006331:Heart Diseases / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D019737:Transplants; D014655:Vascular Resistance