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
36(9).
p.940-947
- 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.
(Less)
- author
- Bergenfeldt, Henrik
LU
; Stehlik, Josef
; Höglund, Peter
LU
; Andersson, Bodil
LU
and Nilsson, Johan
LU
- organization
- publishing date
- 2017
- 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
- volume
- 36
- issue
- 9
- pages
- 940 - 947
- publisher
- Elsevier
- external identifiers
-
- pmid:28259595
- wos:000409395200005
- 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
- 2025-03-04 17:03:30
@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 <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.</p>}},
author = {{Bergenfeldt, Henrik and Stehlik, Josef and Höglund, Peter and Andersson, Bodil and Nilsson, Johan}},
issn = {{1053-2498}},
keywords = {{Body mass index; Gender-matching; Heart transplantation; Obesity; Size matching; Survival}},
language = {{eng}},
number = {{9}},
pages = {{940--947}},
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}},
doi = {{10.1016/j.healun.2017.02.002}},
volume = {{36}},
year = {{2017}},
}