Donor-recipient height ratio and outcomes in pediatric heart transplantation (original) (raw)
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Pediatric Transplantation, 2010
Heart transplantation is an accepted treatment for infants and children with incurable heart conditions. One of the major limitations to the success of pediatric heart transplantation is the shortage of available donor hearts. Strategies to increase donor organ availability include acceptance of Tang L, Du W, Delius RE, LÕEcuyer TJ, Zilberman MV. Low donorto-recipient weight ratio does not negatively impact survival of pediatric heart transplant patients.
The Egyptian Heart Journal
Background Identifying the factors that can influence the prognosis and final outcomes of pediatric heart transplantation is important and makes it possible to prevent complications and improve outcomes. Coordination of donor characteristics with the recipient in terms of sex, weight, body mass index (BMI), and body surface area (BSA) is an important factor that can influence the outcome of the transplantation. There is still no consensus regarding the role of discrepancy in anthropometrics between donors and recipients. The aim of this study was to investigate the relationship between donor and recipient weight mismatch on the early outcomes of pediatric heart transplantation. In this historical cohort study, 80 children who had underwent heart transplantation for the first time between 2014 and 2019 in Shahid Rajaie Cardiovascular Medical and Research Center in Tehran, Iran, were enrolled and divided into three groups according to donor-to-recipient weight ratio (0.8 < D/RW ≤ 1...
The effects of donor-recipient size disparity in infant and pediatric heart transplantation
The Journal of Thoracic and Cardiovascular Surgery, 1992
The effects of donor-recipient size disparity in infant and pediatric heart transplantation To determine the effect of heart donor and recipient size mismatches in infant and pediatric heart transplantation, we studied all 69 patients (age 1 day to 11 years) having 71 orthotopic heart transplants from 1985 to 1989. Patients were divided into three groups based on donor to recipient weight ratios. Group I comprised 13 heart transplants with a donor to recipient weight ratio less than 0.95 (mean 0.81, range 0.48 to 0.94); group II comprised 29 heart transplants with a weight ratio between 0.95 and 1.60 (mean 1.28); and group III had 27 heart transplants with weight ratios greater than 1.60 (mean 2.2, range 1.61 to 3.09). All chests were closed primarily. The cardiothoracic ratio by chest radiography was significantly larger in group III (p = 0.0002); 75 % of group III patients had periods of lobar or complete lung collapse by chest radiography compared with 28 % of group II and 19% of group I patients (p < 0.05). Despite this, there was no difference in the number of days of ventilator support for any group (p = 0.92). There was no difference in graft ischemic time or inotropic drug use among groups, nor were differences found in the cardiac systolic function parameters of left ventricular preejection time (p = 0.975), left ventricular ejection time (p = 0.975), left ventricular fiber shortening (p =0.97), and left ventricular fractional shortening (p =0.596). Thus despite a high incidence of transient lobar or complete lung collapse in high donor to recipient weight ratio transplants, large donor heart size produces very little clinical impairment in recipient lung function. Size mismatches do not influence cardiac systolic function. Overall, large size mismatches appear to be very well tolerated in infant and pediatric heart transplantation.
Risk Factor Analysis in Pediatric Heart Transplantation
2000
Background: Steady assessment of risk factors will enable identification of patients at higher risk for posttransplant death, and may thus improve organ utilization and outcomes. In this study we aimed to identify the risk factors of mortality in pediatric heart transplantation.
Revista Médica del Hospital General de México, 2016
Background and objectives: Weight mismatch has been a controversial issue in the literature and there is also no agreement on the anthropometric parameter that best predicts outcome in such cases. The purpose of this study was to correlate anthropometric and echocardiographic variables to adequately select donors for cardiac transplant. Methods: A total of 399 adult patients with normal echocardiograms were prospectively and consecutively included. Patients with coronary risk factors, systemic diseases and poor acoustic windows were excluded. Results: The mean age of the population was 43 ± 17 years and 39% were male. All anthropometric variables were associated in a linear, positive and statistically significant manner with each of the echocardiographic variables. Marked variations in weight were accompanied by lesser variations in end-diastolic diameter in both men and women. End-diastolic diameter was greater in patients with normal weight compared to low-weight patients (4.46 ± 0.83 cm vs 4.09 ± 0.68 cm), p = 0.013, and in overweight compared to normal weight patients (4.61 ± 0.88 cm vs 4.46 ± 0.83 cm), p = 0.010, whereas there was no difference between obese and overweight patients (4.74 ± 1.14 cm vs 4.61 ± 0.88 cm), p = 0.760. Conclusion: Although anthropometric variations are associated with changes in heart size, such changes are not echocardiographically relevant. This exploratory study opens the door to further
Pediatric transplantation, 2013
Our aim is to develop and validate an accurate method for estimating TCV using standard echocardiographic imaging that can be easily employed to aid in donor-recipient size matching in pediatric heart transplantation. Thirty patients who underwent Echo and cardiac magnetic resonance imaging (cMRI) were identified. TCV was measured on cMRI. TCV was determined echocardiographically by two methods: a volume measurement using the modified Simpson's method on a four-chamber view of the heart; and a calculated volume measurement which assumed a true-elliptical shape of the heart. These two methods where compared with the value obtained by cMRI using the concordance correlation coefficient (CCC). TCV by method 1 correlated well with cMRI (CCC = 0.98%, CI = 0.97, 0.99). TCV by method 2 had a CCC = 0.90 (CI = 0.9464, 0.9716) when compared to cMRI. Left ventricular end-diastolic volume (LVEDV) also correlated as a predictor of TCV in patients with structurally normal hearts and could be d...
Predictors of Graft Longevity in Pediatric Heart Transplantation
Pediatric Cardiology, 2005
Given the volume of pediatric orthotopic heart transplants (OHTs) at several centers, it is now possible to generate pediatric-specific, single-center OHT survival data. The transplant experience for 152 pediatric OHT patients at our institution was reviewed. The following were noted for each patient: graft survival; immunosuppressant therapy; initial diagnosis; cause of graft failure; clinical status at time of transplant; donor and recipient blood type, sex, weight, and age; ischemic time; previous cardiac surgery; race; and immune status. A series of Kaplan-Meier survival curves were constructed. Univariate comparisons of survival curves were performed with the Breslow test to determine equality of each pair of curves. Only immunosuppression with tacrolimus and an initial diagnosis of noncongenital heart disease positively influenced survival in pediatric OHT patients (p £ 0.021 and p £ 0.03, respectively). The more recently transplanted patients, managed with tacrolimus, had less mortality early after OHT (acute rejection) and less mortality during the period 2 or 3 years after OHT. No other factors, including prior cardiothoracic surgery, sex matching, and race matching, significantly influenced survival. Recently transplanted patients managed with tacrolimus-based immunosuppression and patients with noncongenital cardiomyopathy have significantly superior graft survival.