BACKGROUND The heart transplant (HT) guidelines recommendation to match recipient and donors within 30% of body weight lacks a strong evidence base and is not well established in patients bridged to transplant with left ventricular assist devices (LVAD). In light of the scarcity of donor hearts, we investigated the effect of size mismatch on hemodynamics, one-year survival and length of stay (LOS) following HT. METHODS Single-center retrospective analysis of consecutive HT patients from April 2007 to September 2017. Recipients were divided into 3 cohorts based on donor-to-recipient weight ratio (DRWR): (1) undersized (<0.7), (2) size-matched, (0.7-1.3); (3) oversized (>1.3). RESULTS 288 consecutive patients were identified (mean age 53 ± 11 years; 76% male), 46 were undersized (0.61 ± 0.05), 210 size-matched (0.94 ± 0.16), and 32 oversized (1.65 ± 0.38). There was no significant difference in donor left ventricular end diastolic diameter (LVEDD) between the 3 groups (p = 0.11). The donor/recipient (D/R) predicted heart mass (PHM) was lowest in the undersized group (0.92 ± 0.13). There were no significant differences in 1-year survival in the overall and LVAD cohort (p = 0.65 and 0.59, respectively). Neither donor LVEDD nor D/R PHM differed among survivors or non-survivors. LOS was longer in the undersized group than the size-matched cohort (p = 0.004). The undersized group had hearts with the highest filling pressures and lowest cardiac index at 1 week among the remaining groups (p = 0.009, 0.017, and p = 0.05, respectively). There were no clinically significant differences in hemodynamics at 1 or 6 months. CONCLUSIONS HT undersizing affects hemodynamics early but not later in the course and does not impact 1-year survival. The liberalization of size matching may increase the HT donor pool significantly.

中文翻译：

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通过扩大尺寸匹配来增加心脏移植供体库。

背景技术心脏移植（HT）指南建议在体重的30％以内匹配接受者和供体，但缺乏强有力的证据基础，在桥接左心室辅助装置（LVAD）的患者中也没有很好的依据。鉴于供体心脏的稀缺性，我们调查了大小不匹配对HT术后血液动力学，一年生存率和住院时间（LOS）的影响。方法自2007年4月至2017年9月，对连续性HT患者进行单中心回顾性分析。根据供者与受者体重比（DRWR）将接受者分为3组：（1）体型过小（<0.7），（2）体型匹配，（0.7-1.3）；（3）尺寸过大（> 1.3）。结果确定了288例连续患者（平均年龄53±11岁; 76％男性），46例体重不足（0.61±0.05），210例体重匹配（0.94±0.16），和32个超大尺寸（1.65±0.38）。3组之间的供体左心室舒张末期直径（LVEDD）无显着差异（p = 0.11）。供体/接受者（D / R）预测的心脏质量（PHM）在尺寸过小的组中最低（0.92±0.13）。总体和LVAD队列的1年生存率无显着差异（分别为p = 0.65和0.59）。幸存者或非幸存者之间的供体LVEDD和D / R PHM均无差异。在规模较小的人群中，LOS比在规模匹配的人群中更长（p = 0.004）。在其余组中，体重不足组的心脏在1周时具有最高的充盈压和最低的心脏指数（分别为p = 0.009、0.017和p = 0.05）。在1或6个月时，血流动力学没有临床上的显着差异。结论HT过小会影响血流动力学，但不会影响疗程的后期，并且不会影响1年生存率。大小匹配的自由化可能会显着增加HT供体库。