A novel method of donor‒recipient size matching in pediatric heart transplantation: A total cardiac volume‒predictive model

Szugye, Nicholas A.; Zafar, Farhan; Ollberding, Nicholas J.; Villa, Chet; Lorts, Angela; Taylor, Michael D.; Morales, D.L.; Moore, Ryan

doi:10.1016/j.healun.2020.11.002

Cited by 25 publications

(15 citation statements)

References 17 publications

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“…Unlike in adults, donor gender is also commonly accounted for when assessing organ size for pediatric recipients given discrepancies in thoracic volume and heart size depending upon the child's age and gender. Our group is working to define the optimal method for heart size‐matching for children, with a focus on accurate total cardiac volume (TCV) measurements, but until a validated and clinically reliable method exists to determine TCV, the applications—and limitations—of traditional gender‐ and size‐matching warrant further discussion 13–15 …”

Section: Discussionmentioning

confidence: 99%

“…Although many, including the authors' group, have advocated for the widespread implementation of improved and more precise measurements to ensure optimal size‐matching between recipient and donor, but the most commonly utilized method remains the DRWR 14,19,23–25 . The lower limit of DRWR acceptability is typically cited as a ratio of 0.8, with “oversizing” commonly defined as >1.5 1,7,9,10,21 .…”

Section: Discussionmentioning

confidence: 99%

“…The clinical characteristics of male recipients and donors were essentially identical to females, with the notable exception of body weight. However, recent work has shown that differences in heart size do exist by gender, with female hearts tending to have relatively smaller intracardiac volumes and ventricular wall dimensions 14,23 . Based upon these estimates, one would expect that transplanting an ideal‐sized female heart into a male recipient would result in comparative “undersizing” and therefore yield inferior long‐term survival.…”

Section: Discussionmentioning

confidence: 99%

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Female donor hearts can improve survival for male pediatric heart transplant recipients

Greenberg

Moore

Kulshrestha

et al. 2022

Pediatric Transplantation

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Background: Both gender-and weight-matching between donor and recipient are thought to impact survival in pediatric heart transplantation, with clinical dogma holding that male donor hearts and "ideal" weight-matching yield superior survival.The composite impacts of gender and weight on post-transplant survival (PTS) are understudied. Methods: All pediatric (age <18) heart recipients between 1989 and 2021 with the complete recipient and donor gender and weight data were identified in the United Network for Organ Sharing database. Patients were grouped by recipient-donor gender (M & F) and donor-to-recipient weight ratio (DRWR; undersized [<0.8], ideal-sized [0.8-1.5], oversized [>1.5]).Results: A total of 10 697 patients were identified. Among male recipients, PTS was greatest with oversized DRWR from either male or female donors (median 22.4 and 20.6 years; p < .001 vs. others) and lowest for undersized DRWR from either male or female donors (median 13.4 and 13.2 years; p < .001 vs. others). The majority (64%) of male recipients received ideal-sized DRWR, among which female donor hearts yielded superior survival to males (median 18.9 vs. 17.4 years, p = .014). No differences in PTS existed for female recipients on the basis of gender-match, DRWR, and gender/ DRWR together (all p > .1). Conclusions:When considered together, gender and DRWR pairings impact PTS in male-but not female-pediatric heart transplant recipients. For males receiving idealsized DRWR organs (most common pairing, >60%), male recipients achieve superior survival when female donor hearts are transplanted. These findings suggest that if weight is being used for size-matching, donor gender should also be considered, particularly for male recipients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Female donor hearts can improve survival for male pediatric heart transplant recipients

Greenberg

Moore

Kulshrestha

et al. 2022

Pediatric Transplantation

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“…As an example, heart transplantation performed during the neonatal period is a durable therapy for infants with congenital heart disease, and associated with a minimal need for re-intervention [17]. However, the primary limiting factor is the shortage of donors [17][18][19]. The same holds true for lung transplantation in young infants with surfactant dysfunction disorders and congenital diseases [5,20,21].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, kidney and liver transplantation show good results even with size and/or weight mismatched organs [22][23][24]. Organ size matching is more delicate for heart and lung transplantation [18,21]. Despite surgical organ-specific technical challenges, every neonatal donor could reduce waiting list mortality of small pediatric recipients.…”

Section: Discussionmentioning

confidence: 99%

Neonatal donation: are newborns too young to be recognized?

et al. 2021

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Neonatal organ and tissue donation is not common practice in the Netherlands. At the same time, there is a transplant waiting list for small size-matched organs and tissues. Multiple factors may contribute to low neonatal donation rates, including a lack of awareness of this option. This study provides insight into potential neonatal organ and tissue donors and reports on how many donors were actually reported to the procurement organization. We performed a retrospective analysis of the mortality database and medical records of two largest neonatal intensive care units (NICUs) in the Netherlands. This study reviewed records of neonates with a gestational age >37 weeks and weight >3000g who died in the period from January 1, 2005 through December 31, 2016. During the study period, 259 term-born neonates died in the two NICUs. In total, 132 neonates with general contra-indications for donation were excluded. The medical records of 127 neonates were examined for donation suitability. We identified five neonates with documented brain death who were not recognized as potential organ and/or tissue donors. Of the remaining neonates, 27 were found suitable for tissue donation. One potential tissue donor had been reported to the procurement organization. In three cases, the possibility of donation was brought up by parents.Conclusion: A low proportion (2%) of neonates who died in the NICUs were found suitable for organ donation, and a higher proportion (12%) were found suitable for tissue donation. We suggest that increased awareness concerning the possibility of neonatal donation would likely increase the identification of potential neonatal donors. What is Known:• There is an urgent need for very small organs and tissues from neonatal donorsWhat is New:• A number of neonates who died in the NICU were suitable organ or/and tissue donors but were not recognized as donors.• Knowledge on neonatal donation possibilities is also important for proper counseling of parents who sometimes inquire for the possibility of organ and tissue donation.

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Deep Learning for Automated Measurement of Total Cardiac Volume for Heart Transplantation Size Matching

Szugye,

Mahalingam,

Somasundaram

et al. 2024

Pediatr Cardiol

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Total Cardiac Volume (TCV)-based size matching using Computed Tomography (CT) is a novel technique to compare donor and recipient heart size in pediatric heart transplant that may increase overall utilization of available grafts. TCV requires manual segmentation, which limits its widespread use due to time and specialized software and training needed for segmentation. This study aims to determine the accuracy of a Deep Learning (DL) approach using 3-dimensional Convolutional Neural Networks (3D-CNN) to calculate TCV, with the clinical aim of enabling fast and accurate TCV use at all transplant centers. Ground truth TCV was segmented on CT scans of subjects aged 0–30 years, identified retrospectively. Ground truth segmentation masks were used to train and test a custom 3D-CNN model consisting of a DenseNet architecture in combination with residual blocks of ResNet architecture. The model was trained on a cohort of 270 subjects and a validation cohort of 44 subjects (36 normal, 8 heart disease retained for model testing). The average Dice similarity coefficient of the validation cohort was 0.94 ± 0.03 (range 0.84–0.97). The mean absolute percent error of TCV estimation was 5.5%. There is no significant association between model accuracy and subject age, weight, or height. DL-TCV was on average more accurate for normal hearts than those listed for transplant (mean absolute percent error 4.5 ± 3.9 vs. 10.5 ± 8.5, p = 0.08). A deep learning-based 3D-CNN model can provide accurate automatic measurement of TCV from CT images. This initial study is limited as a single-center study, though future multicenter studies may enable generalizable and more accurate TCV measurement by inclusion of more diverse cardiac pathology and increasing the training data.

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A novel method of donor‒recipient size matching in pediatric heart transplantation: A total cardiac volume‒predictive model

Cited by 25 publications

References 17 publications

Female donor hearts can improve survival for male pediatric heart transplant recipients

Female donor hearts can improve survival for male pediatric heart transplant recipients

Neonatal donation: are newborns too young to be recognized?

Deep Learning for Automated Measurement of Total Cardiac Volume for Heart Transplantation Size Matching

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