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Impact of various sizing metrics on female donor to male recipient heart transplant outcomes
Author(s) -
Hess Nicholas R.,
Hickey Gavin W.,
Sultan Ibrahim,
Wang Yisi,
Kilic Arman
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15748
Subject(s) - medicine , odds ratio , confidence interval , body mass index , heart transplantation , logistic regression , transplantation , cohort
Background This study evaluated the impact of various sizing metrics on outcomes of female donor to male recipient orthotopic heart transplantation (OHT). Methods We queried the United Network of Organ Sharing database to analyze all isolated, primary adult OHTs from January 1, 2010 to January 20, 020. Patients were stratified by donor‐recipient sex pairing. Logistic regression was used to investigate risk‐adjusted effects of current size matching criteria (weight ratio, body mass index [BMI] ratio, predicted heart mass [pHM] ratio) on 1‐year posttransplant mortality. Kaplan–Meier analysis was used to compare posttransplant survival among cohorts. Results A total of 22,450 patients were analyzed, of which 3019 (13.4%) underwent female‐to‐male transplantation. Of sex‐matched pairs, female‐to‐male donation had the lowest proportion of undersized hearts using weight and BMI ratio metrics (10.5% and 5.2%) but had the highest proportion of undersizing using pHM metrics (48.1%) (all p < 0.001). Female‐to‐male recipients had the lowest rate of unadjusted 1‐year survival (90.0%, p = 0.0169), and increased hazards of mortality after risk adjustment (odds ratio [OR]: 1.17, 95% confidence interval [CI]: 1.01–1.36, p = 0.034). Undersizing using pHM (donor‐recipient ratio <0.85) was the only metric found to be associated in increased mortality after risk adjustment (OR: 1.32, 95% CI: 1.02–1.71, p = 0.035). Conclusion Female‐to‐male heart transplantation has the worst survival of all sex‐matching combinations. Although female donors in this cohort are appropriately sized using traditional metrics, half are under‐sized using pHM. This, combined with its strong association with mortality, underscores the importance of routine pHM assessment when evaluating female donors for male recipients.