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Donor-recipient size matching and mortality in heart transplantation : Influence of body mass index and gender

Bergenfeldt, Henrik LU ; Stehlik, Josef; Höglund, Peter LU ; Andersson, Bodil LU and Nilsson, Johan LU (2017) In Journal of Heart and Lung Transplantation
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,... (More)

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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Body mass index, Gender-matching, Heart transplantation, Obesity, Size matching, Survival
in
Journal of Heart and Lung Transplantation
publisher
Elsevier
external identifiers
  • scopus:85014115122
ISSN
1053-2498
DOI
10.1016/j.healun.2017.02.002
language
English
LU publication?
yes
id
e8469950-b986-48f6-ae23-86ac1f446616
date added to LUP
2017-03-24 14:17:45
date last changed
2017-09-10 05:17:22
@article{e8469950-b986-48f6-ae23-86ac1f446616,
  abstract     = {<p>Background: The International Society for Heart and Lung Transplantation (ISHLT) guidelines advise against inappropriate weight match (IWM) for heart transplant, defined as donor weight &lt;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 &lt;18.5; non-obese, BMI 18.5 to 30; and obese, BMI &gt;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 &lt; 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 &lt; 0.001) as well as cumulative mortality (HR = 1.27, 95% CI 1.15 to 1.41, p &lt; 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 &lt; 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 &lt;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.</p>},
  author       = {Bergenfeldt, Henrik and Stehlik, Josef and Höglund, Peter and Andersson, Bodil and Nilsson, Johan},
  issn         = {1053-2498},
  keyword      = {Body mass index,Gender-matching,Heart transplantation,Obesity,Size matching,Survival},
  language     = {eng},
  month        = {02},
  publisher    = {Elsevier},
  series       = {Journal of Heart and Lung Transplantation},
  title        = {Donor-recipient size matching and mortality in heart transplantation : Influence of body mass index and gender},
  url          = {http://dx.doi.org/10.1016/j.healun.2017.02.002},
  year         = {2017},
}