• Kyle W Riggs, Courtney M Giannini, Nicholas Szugye, Jason Woods, Clifford Chin, Ryan A Moore, MoralesDavid L SDLSDivision of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio., and Farhan Zafar.
• Division of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio. Electronic address: kcriggs00@gmail.com.
• J. Thorac. Cardiovasc. Surg. 2019 Dec 1; 158 (6): 1652-1660.e4.

BackgroundAccurately predicting cardiac size by other body parameters has long been problematic to determine whether a donor heart will serve a given waitlist candidate, yet hundreds of heart donors are turned down annually for size mismatch.ObjectivesWe sought to describe how donor body weight parameters are currently utilized in cardiac transplantation and its influence on waitlist outcomes.MethodsFrom the United Network for Organ Sharing database, pediatric (age <18 years) heart transplant candidates were divided into lower quartile, interquartile, and upper quartile categories based on final maximum acceptable donor-candidate weight ratio (DCW), expressed as percentage. Baseline characteristics and waitlist outcomes, including monthly offers/candidate and survival were compared.ResultsOverall median DCW was 200% (range, 159%-241%). Patients with congenital heart disease had higher DCW than those with cardiomyopathy (223% vs 203%; P < .001). Number of monthly offers/candidate (5.0, 5.6, and 7.2, respectively; P < .001) increased with quartile of DCW. Posttransplant survival was similar amongst the groups (log-rank P > .05). Subgroup analysis of critically ill children showed a waitlist survival advantage in those listed with a DCW ≥200% (P < .001).ConclusionsDespite substantial practice variation in acceptable donor weight in pediatric heart transplantation, patients listed with variable DCW had similar posttransplant survival. However, in critically ill patients, higher DCW was associated with greater waitlist survival. Better understanding of the importance of donor weight could reduce practice variability and improve organ use and waitlist outcomes for pediatric cardiac transplant candidates.Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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