To exploring the impact of donor-recipient predicted heart mass (PHM) matching on short to mid-term prognosis of adult (≥18 years old) heart transplantation.

The clinical data of adult patients who received orthotopic heart transplantation in the Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2015 to 2019 were retrospectively analyzed. The recipients whose donor-recipient PHM relative differences were greater than 15%, were classified into the oversized group; those whose donor-recipient PHM relative differences were less than -15%, were classified into the undersized group; the others whose absolute value of donor-recipient PHM relative differences were within 15%, were classified into the matched group. The baseline data, perioperative data, matching data of donor and recipient, perioperative data and prognosis among the three groups were compared. The non-normal distribution measurement data among the three groups were compared by Kruskal-Wallis H test. The enumeration data among the three groups were compared by chi-square test or Fisher′s exact probability method. The Spearman rank correlation analysis method was used to analyse the correlation between PHM relative difference and height or weight relative difference. The Kaplan-Meier method was used to draw the postoperative 1-year survival curve of the three groups and the postoperative 1-year survival rate among the three groups was compared with log-rank test. Univariate and multivariate Cox proportional hazards model was used to evaluate the association between different PHM types and covariates and the risk of death at 1 year after transplantation. P<0.05 was considered statistically significant.

Four hundred and nine heart transplantation recipients were included, of which 57 were in the donor undersized group, 248 were in the donor matched group, and 104 were in the donor oversized group. The difference of gender of donors and recipients, and height, weight, preoperative hemoglobin, preoperative serum creatinine, left atrial diameter and left ventricular internal diameter of recipients among the three groups were statistically significant (χ²=70.396 and 124.77, H=95.609, 127.251, 20.551, 10.557, 10.048 and 16.829, all P <0.05). The difference of relative difference in PHM, weight, height, donor-recipient gender matching among the three groups were statistically significant (H=309.231, 198.337 and 175.310, χ²=288.827, P all <0.05). The relative difference in PHM was significantly related to the relative difference in weight and height (r=0.863 and 0.720, all P<0.05). The difference of postoperative IABP usage rate, incidience of respiratory complications, left atrial and right atrium diameter of recipients among the three groups were statistical difference significant (χ²=6.619 and 6.313, H=12.915 and 10.727, all P<0.05). The 1-year cumulative survival rates of the donor oversized group, the matched group, and the donor undersized group were 84.6%, 84.5%, and 93%, respectively, which were not statistically significant (χ²=2.998, P>0.05). The results of univariate Cox proportional hazards model showed that preoperative hemoglobin, serum creatinine, left ventricular internal diameter and age of recipients had strong effect on 1 year death rate (HR=0.980, 1.004, 0.831 and 1.036, all P<0.05). The results of multivariate Cox proportional hazards model showed that preoperative hemoglobin and left ventricular internal diameter of recipients were the independent protective factors for 1 year death rate (HR=0.982 and 0.839, all P<0.05), and the age and preoperative total bilirubin were the independent risk factors (HR=1.048 and 1.017, all P<0.05).

The different type of donor-recipient PHM matching has no significant effect on the 1 year death rate after heart transplantation, and preoperative hemoglobin and left ventricular internal diameter were the independent protective factors for 1 year death rate, and age and total bilirubin of recipients were the independent risk factors for 1 year death rate.