Abstract 18130: Quantitative Heart Measures Are More Predictive of 1-Year Mortality Than Weight-Based Donor-Recipient Matching in Heart Transplantation
Abstract Introduction and hypothesis： Donor-recipient matching in heart transplantation (HT) is heavily dependent on weight. The limited pool of donor hearts mandates efforts to expand that pool without compromising outcomes. We evaluated the impact of matching based on quantitative heart measures (QHMs) on 1-year survival after HT. Methods： Data from the United Network for Organ Sharing (UNOS) registry was used to calculate QHMs of both donors and recipients of HT. QHM uses validated mathematical models derived from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort based on height， weight， age， and sex to estimate total ventricular mass (TVM)， total ventricular end-diastolic volume (TVV)， and total cardiac volume (TCV). The matching level of each donor-recipient pair was assessed for each QHM; matched ±25%， undersized and oversized. Association between matching level (by weight， and by each QHM) and 1-year mortality rates were then analyzed. Results： We identified a total of 37，265 donor-recipient pairs between 1987 and 2013. Matching by weight did not have any 1-year mortality (p=0.43) benefit. Under-sizing or over-sizing by TCV had significantly higher 1-year mortality (p<0.001). Over-sizing by either TVM or TVV had significantly higher 1-year mortality (p<0.001， p=0.024， respectively) (Table and Figure). Conclusions： In HT， donor-recipient matching by QHMs derived from height， weight， age， and sex may offer advantages for making decisions about organ suitability over a weight-based algorithm.