Introduction

In pediatric heart transplantation, donor: recipient weight ratio (DRWR) has long been the sole metric for size matching. Total cardiac volume (TCV)-based size matching has emerged as a novel method to precisely identify an upper limit of donor organ size of a heart transplant recipient while minimizing the risk of complications from oversizing. The clinical adoption of donor: recipient volume ratio (DRVR) to prevent short-term adverse outcomes of oversizing is unknown. The purpose of this single-center study is to determine the relationship of DRWR and DRVR to the risk of post-operative complications from allograft oversizing.

Methods

Recipient TCV was measured from imaging studies and donor TCV was calculated from published TCV prediction models. DRVR was defined as donor TCV divided by recipient TCV. The primary outcome was short-term post-transplant complications (SPTC), a composite outcome of delayed chest closure and prolonged intubation > 7 days. A multivariable logistic regression model of DRWR (cubic spline), DRVR (linear) and linear interaction between DRWR and DRVR was used to examine the probability of experiencing a SPTC over follow-up as a function of DRWR and DRVR.

Results

A total of 106 transplant patients’ records were reviewed. Risk of the SPTC increased as DRVR increased. Both low and high DRWR was associated with the SPTC. A logistic regression model including DRWR and DRVR predicted SPTC with an AUROC curve of 0.74. [95% CI 0.62 0.85]. The predictive model identified a “low-risk zone” of donor-recipient size match between a weight ratio of 0.8 and 2.0 and a TCV ratio less than 1.0.

Conclusion

DRVR in combination with DRWR predicts short-term post-transplant adverse events. Accepting donors with high DRWR may be safely performed when DRVR is considered.

中文翻译：

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比较供体和受体的总心脏体积可预测心脏移植后短期不良后果的风险

介绍

在儿科心脏移植中，供体：受体体重比 (DRWR) 长期以来一直是大小匹配的唯一指标。基于总心脏容积 (TC​​V) 的大小匹配已成为一种新方法，可以精确识别心脏移植受者供体器官大小的上限，同时最大限度地降低因尺寸过大引起并发症的风险。临床采用供体：受体体积比 (DRVR) 以防止超大尺寸的短期不良后果尚不清楚。这项单中心研究的目的是确定 DRWR 和 DRVR 与同种异体移植物尺寸过大引起的术后并发症风险之间的关系。

方法

受体 TCV 是根据影像学研究测量的，供体 TCV 是根据已发表的 TCV 预测模型计算的。DRVR 定义为供体 TCV 除以受体 TCV。主要结果是短期移植后并发症 (SPTC)，这是延迟胸腔闭合和长时间插管 > 7 天的复合结果。使用 DRWR（三次样条）、DRVR（线性）和 DRWR 与 DRVR 之间的线性相互作用的多变量逻辑回归模型来检查作为 DRWR 和 DRVR 的函数在随访期间经历 SPTC 的概率。

结果

共审查了 106 名移植患者的病历。SPTC 的风险随着 DRVR 的增加而增加。低和高 DRWR 都与 SPTC 相关。包括 DRWR 和 DRVR 的逻辑回归模型预测 SPTC，AUROC 曲线为 0.74。[95% CI 0.62 0.85]。预测模型确定了供体-受体大小匹配的“低风险区”，体重比为 0.8 和 2.0，TCV 比小于 1.0。

结论

DRVR 结合 DRWR 可预测短期移植后不良事件。当考虑 DRVR 时，可以安全地接受具有高 DRWR 的供体。