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Impact of Various Sizing Metrics on Female Donor to Male Recipient Heart Transplant Outcomes
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  • Nicholas Hess,
  • Gavin Hickey,
  • Ibrahim Sultan,
  • Yisi Wang,
  • Arman Kilic
Nicholas Hess
University of Pittsburgh Medical Center

Corresponding Author:[email protected]

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Gavin Hickey
University of Pittsburgh Medical Center Health System
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Ibrahim Sultan
University of Pittsburgh
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Yisi Wang
University of Pittsburgh Medical Center Health System
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Arman Kilic
University of Pittsburgh Medical Center Health System
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Background: This study evaluated the impact of various sizing metrics on outcomes of female donor to male recipient orthotopic heart transplantation (OHT). Methods: We queried the United Network of Organ Sharing database to analyze all isolated, primary adult OHTs from 1/12010-3/20/2020. Patients were stratified by donor-recipient sex pairing. Logistic regression was used to investigate risk-adjusted effects of current size matching criteria (weight ratio, body mass index (BMI) ratio, predicted heart mass (pHM) ratio) on one-year post-transplant mortality. Kaplan-Meier analysis was used to compare posttransplant survival among cohorts. Results: A total of 22,450 patients were analyzed, of which 3,019 (13.4%) underwent female-to-male transplantation. Of sex-matched pairs, female-to-male donation had the lowest proportion of undersized hearts using weight and BMI ratio metrics (10.5% and 5.2%) but had the highest proportion of undersizing using pHM metrics (48.1%) (all P<0.001). Female-to-male recipients had the lowest rate of unadjusted one-year survival (90.0%, P = 0.0169), and increased hazards of mortality after risk adjustment (OR 1.17, 95% CI 1.01-1.36, P=0.034)). Undersizing using pHM (donor-recipient ratio < 0.85) was the only metric found to be associated in increased mortality after risk adjustment (OR 1.32, 95% CI 1.02 to 1.71, P=0.035). Conclusions: Female-to-male heart transplantation has the worst survival of all sex-matching combinations. Although female donors in this cohort are appropriately sized using traditional metrics, half are under-sized using pHM. This, combined with its strong association with mortality, underscores the importance of routine pHM assessment when evaluating female donors for male recipients.
25 Feb 2021Submitted to Journal of Cardiac Surgery
26 Feb 2021Submission Checks Completed
26 Feb 2021Assigned to Editor
19 Apr 2021Review(s) Completed, Editorial Evaluation Pending
20 Apr 2021Editorial Decision: Accept
Sep 2021Published in Journal of Cardiac Surgery volume 36 issue 9 on pages 3242-3249. 10.1111/jocs.15748