Abstract 2463: Impact of Donor to Recipient Weight Ratio on Survival after Heart Transplantation: Analysis of the United Network for Organ Sharing Database
Introduction: Accepted donor criteria for heart transplantation limit allografts to donors within 20–30% of the recipient’s weight. We analyzed the impact of donor to recipient (DR) weight ratio on survival after heart transplantation.
Methods: Adult heart transplant recipients reported to the United Network for Organ Sharing from 1999–2007 were divided into 3 groups based on DR weight ratio: <0.8, 0.8–1.2, and >1.2. Kaplan-Meier methodology was used to estimate survival. Propensity-adjusted Cox regression modeling was used to analyze predictors of mortality.
Results: 15284 heart transplant recipients were analyzed: 2078 had weight ratio of <0.8, 9684 had 0.8–1.2, and 3522 had >1.2. Survival was not statistically different between groups (Figure⇓). Among patients with weight ratio <0.8, survival was lower for recipients with high pulmonary vascular resistance (PVR) (>4 Woods units) (Figure⇓). Among recipients with high PVR, 5-year survival was similar for those with weight ratio 0.8–1.2 and >1.2 (p=0.44). Propensity-adjusted multivariable analysis demonstrated that weight ratio <0.8 did not predict mortality (HR 1.09; 95% CI 0.94–1.27; p=0.21). Five-year survival after propensity matching was not statistically different between those with weight ratio <0.8 versus ≥0.8 (p=0.37).
Conclusions: Weight ratio did not predict mortality after heart transplantation. Undersized allografts in recipients with normal/low PVR did not adversely effect survival. Oversized allografts in recipients with high PVR did not provide survival advantage over normal-sized allografts. Extending donor criteria to include undersized hearts in select recipients should be considered.