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Choosing wisely: incorporating appropriate donor-recipient size matching in heart transplantation

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Abstract

Historically, transplantation of a female donor heart to male recipient has been viewed with caution given evidence of suboptimal outcomes, particularly in special populations such as patients with pulmonary hypertension or those supported by ventricular assist devices. However, the use of predicted heart mass ratio for donor-recipient size matching demonstrated that the size of the organ rather than sex of the donor was most responsible for the outcomes. With the advent of the predicted heart mass ratio, avoiding female donor hearts for male recipients is no longer justified and may result in unnecessary waste of available organs. In this review, we highlight the value of donor-recipient sizing by predicted heart mass ratio and summarize the evidence of different approaches to the donor-to-recipient size and sex matching. We conclude that the utilization of predicted heart mass is currently considered a preferred method of matching heart donors and recipients.

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References

  1. Costanzo MR, Dipchand A, Starling R et al (2010) The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 29:914–956

    Article  PubMed  Google Scholar 

  2. Chan BB, Fleischer KJ, Bergin JD et al (1991) Weight is not an accurate criterion for adult cardiac transplant size matching. Ann Thorac Surg 52:1230–1235 discussion 1235-6

    Article  CAS  PubMed  Google Scholar 

  3. Fabbri A, Bryan AJ, Sharples LD et al (1992) Influence of recipient and donor gender on outcome after heart transplantation. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 11:701–707

    CAS  PubMed  Google Scholar 

  4. Kirsch M, Baufreton C, Naftel DC, Benvenuti C, Loisance DY (1998) Pretransplantation risk factors for death after heart transplantation: the Henri Mondor experience. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 17:268–277

    CAS  PubMed  Google Scholar 

  5. McCarthy JF, McCarthy PM, Massad MG et al (1998) Risk factors for death after heart transplantation: does a single-center experience correlate with multicenter registries? Ann Thorac Surg 65:1574–1578 discussion 1578-9

    Article  CAS  PubMed  Google Scholar 

  6. Prendergast TW, Furukawa S, Beyer AJ 3rd, Browne BJ, Eisen HJ, Jeevanandam V (1998) The role of gender in heart transplantation. Ann Thorac Surg 65:88–94

    Article  CAS  PubMed  Google Scholar 

  7. Schlechta B, Kocher AA, Ofner P et al (1999) Impact of gender mismatch on the outcome of heart transplantation. Transplant Proc 31:3340–3342

    Article  CAS  PubMed  Google Scholar 

  8. De Santo LS, Marra C, De Feo M, Amarelli C, Romano G, Cotrufo M (2002) The impact of gender on heart transplantation outcomes: a single center experience. Italian Heart Journal : official Journal of the Italian Federation of Cardiology 3:419–423

    PubMed  Google Scholar 

  9. Al-Khaldi A, Oyer PE, Robbins RC (2006) Outcome analysis of donor gender in heart transplantation. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 25:461–468

    Article  PubMed  Google Scholar 

  10. Izquierdo MT, Almenar L, Martínez-Dolz L et al (2007) Analysis of the impact of donor gender on early mortality. Transplant Proc 39:2375–2376

    Article  CAS  PubMed  Google Scholar 

  11. Tsao CI, Chen RJ, Chou NK et al (2008) The influence of gender on survival after heart transplantation. Transplant Proc 40:2634–2635

    Article  CAS  PubMed  Google Scholar 

  12. Welp H, Spieker T, Erren M, Scheld HH, Baba HA, Stypmann J (2009) Sex mismatch in heart transplantation is associated with increased number of severe rejection episodes and shorter long-term survival. Transplant Proc 41:2579–2584

    Article  CAS  PubMed  Google Scholar 

  13. Kittleson MM, Shemin R, Patel JK et al (2011) Donor-recipient sex mismatch portends poor 10-year outcomes in a single-center experience. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 30:1018–1022

    Article  PubMed  Google Scholar 

  14. Jalowiec A, Grady KL, White-Williams C (2012) First-year clinical outcomes in gender-mismatched heart transplant recipients. The Journal of Cardiovascular Nursing 27:519–527

    Article  PubMed  PubMed Central  Google Scholar 

  15. Eifert S, Kofler S, Nickel T et al (2012) Gender-based analysis of outcome after heart transplantation. Experimental and Clinical Transplantation : official Journal of the Middle East Society for Organ Transplantation 10:368–374

    Article  PubMed  Google Scholar 

  16. Taghavi S, Wilson LM, Brann SH, Gaughan J, Mangi AA (2012) Cardiac transplantation can be safely performed with low donor-to-recipient body weight ratios. J Card Fail 18:688–693

    Article  PubMed  Google Scholar 

  17. Correia P, Prieto D, Batista M, Antunes MJ (2014) Gender mismatch between donor and recipient is a factor of morbidity but does not condition survival after cardiac transplantation. Transplant international : official Journal of the European Society for Organ Transplantation 27:1303–1310

    Article  PubMed  Google Scholar 

  18. Kaczmarek I, Meiser B, Beiras-Fernandez A et al (2013) Gender does matter: gender-specific outcome analysis of 67,855 heart transplants. Thorac Cardiovasc Surg 61:29–36

    PubMed  Google Scholar 

  19. Khush KK, Kubo JT, Desai M (2012) Influence of donor and recipient sex mismatch on heart transplant outcomes: analysis of the International Society for Heart and Lung Transplantation registry. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 31:459–466

    Article  PubMed  Google Scholar 

  20. Martinez-Selles M, Almenar L, Paniagua-Martin MJ et al (2015) Donor/recipient sex mismatch and survival after heart transplantation: only an issue in male recipients? An analysis of the Spanish heart transplantation registry. Transplant International : official Journal of the European Society for Organ Transplantation 28:305–313

    Article  PubMed  Google Scholar 

  21. Weiss ES, Allen JG, Patel ND et al (2009) The impact of donor-recipient sex matching on survival after orthotopic heart transplantation: analysis of 18 000 transplants in the modern era. Circulation Heart failure 2:401–408

    Article  PubMed  Google Scholar 

  22. Stehlik J, Feldman DS, Brown RN et al (2010) Interactions among donor characteristics influence post-transplant survival: a multi-institutional analysis. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 29:291–298

    Article  PubMed  Google Scholar 

  23. Bergenfeldt H, Stehlik J, Höglund P, Andersson B, Nilsson J (2017) Donor-recipient size matching and mortality in heart transplantation: influence of body mass index and gender. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 36:940–947

    Article  PubMed  Google Scholar 

  24. Zhu Y, Shudo Y, Lingala B, Joseph WY (2021) The impact of donor sex on heart transplantation outcomes-a study of over 60,000 patients in the United States. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation

  25. Barac YD, Jawitz OK, Hartwig MG et al (2021) Mitigating the impact of using female donor hearts in male recipients using BMI difference. Ann Thorac Surg 111:1299–1307

    Article  PubMed  Google Scholar 

  26. Rudasill SE, Sanaiha Y, Mardock AL et al (2020) Height mismatch: an overlooked component of adult heart transplant outcomes. Clin Transpl 34:e13863

    Article  CAS  Google Scholar 

  27. Reed RM, Netzer G, Hunsicker L et al (2014) Cardiac size and sex-matching in heart transplantation : size matters in matters of sex and the heart. JACC Heart Failure 2:73–83

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bluemke DA, Kronmal RA, Lima JA et al (2008) The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (multi-ethnic study of atherosclerosis) study. J Am Coll Cardiol 52:2148–2155

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kransdorf EP, Kittleson MM, Benck LR et al (2019) Predicted heart mass is the optimal metric for size match in heart transplantation. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 38:156–165

    Article  PubMed  Google Scholar 

  30. Gong TA, Joseph SM, Lima B et al (2018) Donor predicted heart mass as predictor of primary graft dysfunction. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 37:826–835

    Article  PubMed  Google Scholar 

  31. Holzhauser L, Imamura T, Bassi N et al (2019) Increasing heart transplant donor pool by liberalization of size matching. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 38:1197–1205

    Article  PubMed  Google Scholar 

  32. Shah M, Saeed O, Shin J et al (2020) Predicted heart mass-based size matching among recipients with moderate pulmonary hypertension: outcomes and sex effect. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 39:648–656

    Article  PubMed  Google Scholar 

  33. Cheshire C, Kydd A, Nerlekar N et al (2021) Size matching in heart transplantation: is predicted heart mass the optimal method in a United Kingdom cohort? Clin Transpl 35:e14192

    Article  Google Scholar 

  34. Miller RJH, Hedman K, Amsallem M et al (2021) Donor and recipient size matching in heart transplantation with predicted heart and lean body mass. Semin Thorac Cardiovasc Surg

  35. Khush KK, Cherikh WS, Chambers DC et al (2019) The international thoracic organ transplant registry of the International Society for Heart and Lung Transplantation: thirty-sixth adult heart transplantation report - 2019; focus theme: donor and recipient size match. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 38:1056–1066

    Article  PubMed  Google Scholar 

  36. Copeland H, Knezevic I, Baran DA et al (2023) Donor heart selection: evidence-based guidelines for providers. The Journal of Heart and Lung Transplantation : the official publication of the International Society for Heart Transplantation 42:7–29

    Article  PubMed  Google Scholar 

  37. Hess NR, Hickey GW, Sultan I, Wang Y, Kilic A (2021) Impact of various sizing metrics on female donor to male recipient heart transplant outcomes. J Card Surg

  38. Kawabori M, Critsinelis AC, Hironaka CE et al (2021) Right ventricular undersizing is associated with increased 1-year mortality. J Thorac Cardiovasc Surg 161:1048–1059.e3

    Article  PubMed  Google Scholar 

  39. Clark DE, Byrne RD, Mazurek JA et al (2020) Sizing heart transplant donors in adults with congenital heart disease. J Thorac Cardiovasc Surg

  40. Kwon MH, Wong S, Kittleson M et al (2014) Selecting oversized donor cardiac allografts for patients with pulmonary hypertension may be unnecessary. Transplant Proc 46:1497–1501

    Article  CAS  PubMed  Google Scholar 

  41. Patel ND, Weiss ES, Nwakanma LU et al (2008) Impact of donor-to-recipient weight ratio on survival after heart transplantation: analysis of the united network for organ sharing database. Circulation 118:S83–S88

    Article  PubMed  Google Scholar 

  42. Bangalore BS, Devaraj S, Denlinger C et al (2022) Predicted heart mass (PHM) ratio for size matching in heart transplant post LVAD. J Heart Lung Transplant 41:S175

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiovascular, Department of Medicine, Indiana University School of Medicine, 1801 Senate Avenue Suite 2000, DiseaseIndianapolis, IN, 46202, USA

    Maya Guglin & Elie Kozaily

  2. Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, CA, Los Angeles, USA

    Michelle M. Kittleson

Authors
  1. Maya Guglin
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  2. Elie Kozaily
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  3. Michelle M. Kittleson
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Contributions

Dr. Guglin: concept, design, literature search, data collection and analysis, manuscript writing. Dr. Kozaily: literature search, manuscript writing. Dr. Kittleson: reviewing and editing the drat.

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Correspondence to Maya Guglin.

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Guglin, M., Kozaily, E. & Kittleson, M.M. Choosing wisely: incorporating appropriate donor-recipient size matching in heart transplantation. Heart Fail Rev 28, 967–975 (2023). https://doi.org/10.1007/s10741-023-10299-1

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