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Increasing Infant Donor-Recipient Weight Mismatch Is Associated With Shorter Waitlist Duration And No Increased Morbidity Or Mortality
Bahaaldin Alsoufi, MD1, Deborah Kozik1, Shriprassad Deshpande2, Joshua Sparks1, Sarah Wilkens1, Erle Austin1, Jaimin Trivedi1.
1University of Louisville, Louisville, KY, USA, 2Children's National Hospital, Washington, DC, USA.

Abstract: Infants awaiting pediatric heart transplantation (PHT) experience long waitlist and high mortality. Using UNOS database, we explored if increasing donor-recipient weight ratio (DRWR) >2.0 (recommended cutoff) was associated with adverse outcomes.
Methods: Between 2007-2020, 1392 infants (<1-year) received PHT. They were divided to 3 groups: A (DRWR ≤1.0,n=239,17%), B (DRWR 1.0-2.0,n=947,68%), C (DRWR >2.0,n=206,15%). We compared group characteristics and PHT outcomes.
Results: DRWR range was 0.5-4.1. Underlying pathology (congenital vs. cardiomyopathy), gender, race, renal function, and mechanical circulatory support were comparable between groups. Group-C patients were more likely to be ventilated, receive ABO-incompatible heart, have longer donor ischemic time. Waitlist duration was significantly shorter for Group-C (33 vs. 50 days,p<0.1). Early outcomes for groups A,B,C were the following (respectively): operative death (6%,4%,3%,p=0.29), primary graft dysfunction (5%,3%,3%,p=0.30), renal failure (10%,7%,7%,p=0.42), stroke (3%,4%,1%,p=0.36). DRWR group wasn’t associated with mortality for congenital (OR=0.819,95%CI=0.523-1.282) or cardiomyopathy patients (OR=1.221,95%CI=0.780-1.912). Only pre-PHT ECMO was associated with mortality (OR=4.400,95%CI=2.761-7.010). Additionally, survival at 1-year (87%,87%,85%,p=0.80) and 5-years (76%,78%,77%,p=0.80) was comparable between DRWR groups.
Conclusions: Infants who received PHT with DRWR >2.0 (up to 4.1) experienced shorter waitlist duration and no increase in peri-transplant complications, operative or late mortality. Historic practice to avoid DRWR>2.0 due to complications (e.g. hypertension-related stroke, graft dysfunction, death) is not currently supported in infants. Stretching DRWR acceptance criteria would decrease PHT waitlist duration and potentially waitlist complications and mortality.


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