背景:迄今为止,没有研究确定在小儿心脏移植(HT)中匹配供体-受体(D-R)对的最佳指标.
目的:本研究试图确定预测移植移植后存活的大小不匹配指标。
方法:从1993年到2021年,儿童心脏移植协会数据库中接受HT的D-R对被包括在内。高度大小不匹配的影响,体重,身体质量指数,体表面积,预测心脏质量,评估了1年和5年移植物存活率和发病率结局(排斥反应和心脏同种异体移植物血管病变)的总心脏容积(TCV).具有逐步选择的Cox模型鉴定了独立预测移植物存活的大小度量。
结果:在7,715个D-R对中,36.0%的重量匹配良好(D-R比率:-20%至20%),按预测心脏质量计算的39.0%,按体表面积计算50.0%,体重指数57.0%,身高71.0%,和93.0%的TCV。在所有尺寸度量中,只有高度和TCV的D-R错配可以预测1年和5年的移植物存活。D-R大小错配对移植物存活的影响是非线性的。在HT后的1年和5年,D-R尺寸过小和高度过大导致移植物损失增加,与移植物损失观察到更频繁与不足。身高中等偏小的供体(D-R比率:<-30%)经常经历HT后的排斥反应(P<0.001)。通过TCV评估D-R大小匹配,最小的供体尺寸不足是保护性的,而高达25%的过大与移植物损失增加无关。
结论:在儿科HT中,使用TCV,D-R看起来最佳匹配。只有通过TCV和高度的D-R大小错配独立地预测移植物存活。标准化跨中心的大小匹配可以减少供体丢弃。
BACKGROUND: To date, no studies have identified an optimal metric to match donor-recipient (D-R) pairs in pediatric heart transplantation (HT).
OBJECTIVE: This study sought to identify size mismatch metrics that predicted graft survival post-HT.
METHODS: D-R pairs undergoing HT in Pediatric Heart Transplant Society database from 1993 to 2021 were included. Effects of size mismatch by height, weight, body mass index, body surface area, predicted heart mass, and total cardiac volume (TCV) on 1- and 5-year graft survival and morbidity outcomes (rejection and cardiac allograft vasculopathy) were evaluated. Cox models with stepwise selection identified size metrics that independently predicted graft survival.
RESULTS: Of 7,715 D-R pairs, 36.0% were well matched (D-R ratio: -20% to +20%) by weight, 39.0% by predicted heart mass, 50.0% by body surface area, 57.0% by body mass index, 71.0% by height, and 93.0% by TCV. Of all size metrics, only D-R mismatch by height and TCV predicted graft survival at 1 and 5 years. Effects of D-R size mismatch on graft survival were nonlinear. At both 1 and 5 years post-HT, D-R undersizing and oversizing by height led to increased graft loss, with graft loss observed more frequently with undersizing. Moderately undersized donors by height (D-R ratio: <-30%) frequently experienced rejection post-HT (P < 0.001). Assessing D-R size matching by TCV, minimal donor undersizing was protective, while oversizing up to 25% was not associated with increased graft loss.
CONCLUSIONS: In pediatric HT, D-R appear most optimally matched using TCV. Only D-R size mismatch by TCV and height independently predicts graft survival. Standardizing size matching across centers may reduce donor discard.