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Central Surgical Association

49th Annual Meeting

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Female Donor Hearts Improve Survival for the Majority of Pediatric Male Heart Transplant Recipients
Jason W. Greenberg, Ryan A. Moore, Angela Lorts, Tanya Perry, Bin Huang, Chen Chen, David L. Morales, Farhan Zafar
The Heart Institute; Division of Congenital Cardiovascular Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Purpose: Graft size is an important consideration in pediatric heart transplant (HTx), with donor-to-recipient weight ratios (DRWR) widely used. However, body weight can be a suboptimal surrogate with other factors – such as gender – also impacting organ size and possibly function. We therefore sought to determine the impact of gender and DRWR together on post-HTx survival (PTS).

Methods: UNOS was used to identify 10,394 patients <18 who received first-time HTx between 1998-2020. Patients were categorized by donor- and recipient gender (M, F) and DRWR. DRWR groups were: <0.8 (undersized), 0.8-1.5 (ideal), and >1.5 (oversized). The primary variable of interest was PTS in median years (yr).

Results: Comparing DRWR alone, PTS was worse in undersized vs. ideal (p=0.02) & oversized (p<0.01), but ideal vs. oversized PTS was similar (p=0.29). Gender match/mismatch alone also did not impact PTS (p>0.1 for all). 12 gender-DRWR pairing groups were identified (Table). PTS was greatest in M recipients with oversized DRWR (M donor, median survival 21.1 yr; F donor, 20.6; M vs F, p=0.212) and was significantly greater than with undersized DRWR (p<0.01) for both donor genders (M donor, 12.4; F donor, 13.0; M vs F, p=0.71). However, ideal DRWR was used in the majority (64%) of patients, M & F alike. In M with ideal DRWR, PTS was greater with F than M donors (17.6 vs. 15.3, p=0.03). Although the lowest overall median survival at 12 yr was seen in F recipients with F donor & undersized DRWR, there were no differences in PTS between any F recipient groups (p>0.09 for all). Covariate balancing propensity scoring confirmed these trends.

Conclusions: When considered together, gender- and DRWR-pairings impacted post-transplant survival in males but not female recipients. Within ideal DRWR groups (most common pairing, >60%), M recipients had 15% greater survival with F donors over M donors. Our findings suggest that both gender and weight should be accounted for when accepting hearts, particularly for M children.


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