Henrik Bergenfeldt1, Josef Stehlik2, Peter Höglund3, Bodil Andersson4, Johan Nilsson5. 1. Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skåne University Hospital, Lund, Sweden. 2. Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA; International Society for Heart and Lung Transplantation, Dallas, Texas, USA. 3. Department of Laboratory Medicine, Lund, Clinical Chemistry and Pharmacology, Lund University and Skåne University Hospital, Lund, Sweden; and. 4. Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden. 5. Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skåne University Hospital, Lund, Sweden. Electronic address: johan.nilsson@med.lu.se.
Abstract
BACKGROUND: The International Society for Heart and Lung Transplantation (ISHLT) guidelines advise against inappropriate weight match (IWM) for heart transplant, defined as donor weight <70% of recipient's weight. Few studies have explored in detail this size-matching recommendation, especially with regard to body mass index (BMI) and gender matching. We aimed to determine whether any difference could be observed between size-matching in obese and non-obese recipients with regard to mortality after cardiac transplantation. METHODS: Data from 52,455 adult heart transplants (recipients ≥18 years of age) between 1994 and 2013 were obtained from the ISHLT Registry. We defined the following subgroups of patients based on BMI: underweight, BMI <18.5; non-obese, BMI 18.5 to 30; and obese, BMI >30. The end-points were all-cause 30-day mortality and cumulative mortality. RESULTS: IWM was associated with increased 30-day mortality (odds ratio [OR] = 1.20, 95% confidence interval [CI] 1.01 to 1.43, p = 0.041) and cumulative mortality (hazard ratio [HR] = 1.14, 95% CI 1.07 to 1.22, p < 0.001). In non-obese recipients, IWM was associated with increased 30-day mortality (OR = 1.89, 95% CI 1.48 to 2.41, p < 0.001) as well as cumulative mortality (HR = 1.27, 95% CI 1.15 to 1.41, p < 0.001), whereas, for obese recipients, IWM was not associated with 30-day or cumulative mortality. Male recipients of female allografts (HR = 1.08, 95% CI 1.04 to 1.12, p < 0.001) as well as female recipients of male allografts (HR = 1.07, 95% CI 1.02 to 1.13, p = 0.003) had increased cumulative mortality compared with gender-matched transplants. There was no interaction between IWM and gender mismatch. CONCLUSIONS: Our results indicate that donor weight <70% of recipient weight increases mortality in non-obese heart transplant recipients, but not in obese transplant recipients. Gender mismatch increases mortality independently of weight match.
BACKGROUND: The International Society for Heart and Lung Transplantation (ISHLT) guidelines advise against inappropriate weight match (IWM) for heart transplant, defined as donor weight <70% of recipient's weight. Few studies have explored in detail this size-matching recommendation, especially with regard to body mass index (BMI) and gender matching. We aimed to determine whether any difference could be observed between size-matching in obese and non-obese recipients with regard to mortality after cardiac transplantation. METHODS: Data from 52,455 adult heart transplants (recipients ≥18 years of age) between 1994 and 2013 were obtained from the ISHLT Registry. We defined the following subgroups of patients based on BMI: underweight, BMI <18.5; non-obese, BMI 18.5 to 30; and obese, BMI >30. The end-points were all-cause 30-day mortality and cumulative mortality. RESULTS: IWM was associated with increased 30-day mortality (odds ratio [OR] = 1.20, 95% confidence interval [CI] 1.01 to 1.43, p = 0.041) and cumulative mortality (hazard ratio [HR] = 1.14, 95% CI 1.07 to 1.22, p < 0.001). In non-obese recipients, IWM was associated with increased 30-day mortality (OR = 1.89, 95% CI 1.48 to 2.41, p < 0.001) as well as cumulative mortality (HR = 1.27, 95% CI 1.15 to 1.41, p < 0.001), whereas, for obese recipients, IWM was not associated with 30-day or cumulative mortality. Male recipients of female allografts (HR = 1.08, 95% CI 1.04 to 1.12, p < 0.001) as well as female recipients of male allografts (HR = 1.07, 95% CI 1.02 to 1.13, p = 0.003) had increased cumulative mortality compared with gender-matched transplants. There was no interaction between IWM and gender mismatch. CONCLUSIONS: Our results indicate that donor weight <70% of recipient weight increases mortality in non-obese heart transplant recipients, but not in obese transplant recipients. Gender mismatch increases mortality independently of weight match.
Authors: Kiran K Khush; Wida S Cherikh; Daniel C Chambers; Michael O Harhay; Don Hayes; Eileen Hsich; Bruno Meiser; Luciano Potena; Amanda Robinson; Joseph W Rossano; Aparna Sadavarte; Tajinder P Singh; Andreas Zuckermann; Josef Stehlik Journal: J Heart Lung Transplant Date: 2019-08-10 Impact factor: 10.247
Authors: Daniel C Chambers; Wida S Cherikh; Michael O Harhay; Don Hayes; Eileen Hsich; Kiran K Khush; Bruno Meiser; Luciano Potena; Joseph W Rossano; Alice E Toll; Tajinder P Singh; Aparna Sadavarte; Andreas Zuckermann; Josef Stehlik Journal: J Heart Lung Transplant Date: 2019-08-08 Impact factor: 10.247
Authors: Fouad Chouairi; Aidan Milner; Sounok Sen; Avirup Guha; James Stewart; Ania M Jastreboff; Makoto Mori; Katherine A Clark; P Elliott Miller; Michael A Fuery; Joseph G Rogers; Andrew Notarianni; Daniel Jacoby; Christopher Maulion; Muhammad Anwer; Arnar Geirsson; Nihar R Desai; Tariq Ahmad; Clancy W Mullan Journal: J Am Heart Assoc Date: 2021-12-02 Impact factor: 6.106
Authors: Joanna E Śliwka; Roman Przybylski; Anna Dołaszyńska-Żółkiewska; Adam Sokal; Mirosław Tyrpień; Piotr M Wilczek; Marian Zembala Journal: Kardiochir Torakochirurgia Pol Date: 2018-09-24
Authors: Nadia Iannino; Amine Nasri; Agnès Räkel; Anique Ducharme; Kim Lachance; Normand Racine; Simon de Denus; Maxime Tremblay-Gravel; Annik Fortier; Michel White Journal: J Transplant Date: 2018-11-08
Authors: Ashley Y Choi; Michael S Mulvihill; Hui-Jie Lee; Congwen Zhao; Maragatha Kuchibhatla; Jacob N Schroder; Chetan B Patel; Christopher B Granger; Matthew G Hartwig Journal: JAMA Cardiol Date: 2020-06-01 Impact factor: 14.676