BACKGROUND
The pediatric heart transplant community uses weight-based donor-to-recipient size
matching almost exclusively, despite no evidence to validate weight as a reliable
surrogate of cardiac size. Donor size mismatch is the second most common reason for
the refusal of donor hearts in current practice (∼30% of all refusals). Whereas case-by-case
segmentation of total cardiac volume (TCV) by computed tomography (CT) for direct
virtual transplantation is an attractive option, it remains limited by the unavailability
of donor chest CT. We sought to establish a predictive model for donor TCV on the
basis of anthropomorphic and chest X-ray (CXR) cardiac measures.
METHODS
Banked imaging studies from 141 subjects with normal CT chest angiograms were obtained
and segmented using 3-dimensional modeling to derive TCV. CXR data were available
for 62 of those subjects. A total of 3 predictive models of TCV were fit through multiple
linear regression using the following variables: Model A (weight only); Model B (weight,
height, sex, and age); Model C (weight, height, sex, age, and 1-view anteroposterior
CXR maximal horizontal cardiac width).
RESULTS
Model C provided the most accurate prediction of TCV (optimism corrected R2 = 0.99, testing set R2 = 0.98, mean absolute percentage error [MAPE] = 8.6%) and outperformed Model A (optimism
corrected R2 = 0.94, testing set R2 = 0.94, MAPE = 16.1%) and Model B (optimism corrected R2 = 0.97, testing set R2 = 0.97, MAPE = 11.1%).
CONCLUSIONS
TCV can be predicted accurately using readily available anthropometrics and a 1-view
CXR from donor candidates. This simple and scalable method of TCV estimation may provide
a reliable and consistent method to improve donor size matching.
KEYWORDS
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Heart and Lung TransplantationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pediatric heart transplant waiting list mortality in the era of ventricular assist devices.J Heart Lung Transplant. 2015; 34: 82-88
- Time for evidence-based, standardized donor size matching for pediatric heart transplantation.J Thorac Cardiovasc Surg. 2019; 158 (1652-1660.e4)
- Pediatric marginal donor hearts: trends in US national use, 2005-2014.Pediatr Transplant. 2018; 22: e13216
- The number of refusals for donor organ quality does not impact heart transplant outcomes in children.Ann Thorac Surg. 2018; 105: 1223-1230
- Use of height and a novel echocardiographic measurement to improve size-matching for pediatric heart transplantation.J Heart Lung Transplant. 2012; 31: 896-902
- Impact of donor-to-recipient weight ratio on survival after heart transplantation: analysis of the United Network for Organ Sharing Database.Circulation. 2008; 118: S83-S88
- Influence of size disparity of transplanted hearts on cardiac growth in infants and children.J Thorac Cardiovasc Surg. 2012; 143: 168-177
- Can virtual heart transplantation via 3-dimensional imaging increase the maximum acceptable donor size?.J Heart Lung Transplant. 2019; 38: 331-333
- Alternative methods for virtual heart transplant-size matching for pediatric heart transplantation with and without donor medical images available.Pediatr Transplant. 2018; 22: e13290
- Expanding the donor pool for congenital heart disease transplant candidates by implementing 3D imaging-derived total cardiac volumes.Pediatr Transplant. 2020; 24: e13639
- A formula to estimate the approximate surface area if height and weight be known. 1916.Nutrition. 1989; 5: 303-313
- Calculation of the cardiothoracic ratio from portable anteroposterior chest radiography.J Korean Med Sci. 2011; 26: 1446-1453
- Is there any diagnostic value of anteroposterior chest radiography in predicting cardiac chamber enlargement?.Int J Cardiovasc Imaging. 2019; 35: 195-206
R Foundation for Statistical Computing. R Core Team: a language and environment for statistical computing. Available at: https://www.r-project.org/.
- Cardiovascular allometry: analysis, methodology, and clinical applications.Adv Exp Med Biol. 2018; 1065: 207-224
- On growth and form.Cambridge University Press, Cambridge1917
- Donor predicted heart mass as predictor of primary graft dysfunction.J Heart Lung Transplant. 2018; 37: 826-835
- Effect of oversizing cardiac allografts on survival in pediatric patients with congenital heart disease.J Heart Lung Transpl. 2005; 24: 195-199
- Predicted heart mass for donor organ allocation: getting closer to the target.Circ Heart Fail. 2019; 12e006634
- Predicted heart mass is the optimal metric for size matching in heart transplantation.J Heart Lung Transpl. 2017; 36: S113-S114
Dani A, Szugye NA, Thangappan K, et al. Total cardiac volume ratio, unlike donor-recipient weight ratio, correlates with pediatric heart transplant survival. In: Paper presented at: ASAIO Virtual On Demand; June 1, 2020. Available at: https://asaio.org/virtual/2020/preview.cgi?.
Article info
Publication history
Published online: December 04, 2020
Identification
Copyright
© 2020 International Society for Heart and Lung Transplantation. All rights reserved.
