Using BMI vs Weight Leads to Improved Donor-Recipient Matching in Pediatric Heart Transplantation

A toddler girl sits on a table during a medical examination. A female medical professional is using a stethoscope to listen to her heartbeat. The child is smiling up at her doctor.
Researchers examined the outcomes of using BMI or BSA, instead of weight, on pediatric heart transplant donor-recipient matching.

The following article is a part of conference coverage from the American College of Cardiology’s 71st Annual Scientific Session & Expo being held in Washington, DC, from April 2 to 4, 2022. The team at Cardiology Advisor will be reporting on the latest news and research conducted by clinicians and scientists in the field. Check back for more from the ACC 2022 .


Body mass index (BMI) may be more effective than the traditional body weight metric for matching donor and recipient size for pediatric heart transplantation, according to study findings presented at the American College of Cardiology’s (ACC) 71st Annual Scientific Session & Expo, from April 2 to 4, 2022, in Washington, DC.

Since using body weight has led to size mismatching in pediatric heart transplantation, researchers hypothesized that using compound measures like BMI and body surface area (BSA) could affect outcomes of pediatric heart transplants.

For the analysis, researchers conducted a retrospective study of 4465 pediatric patients who received a heart transplant. Using data from the United Network for Organ Sharing database, investigators divided patients into cohorts of congenital heart disease (CHD) (43%) and non-CHD (57%). Mismatch tertiles for donor and recipients were established for weight, BMI, and BSA ratios. One-year survival as a result of each mismatch was calculated with multivariable analysis. Univariate analysis was used to document differences in patients’ characteristics.

Results showed that recipients with a low donor-recipient ratio for BMI were less likely to be White, more likely to be younger, and received extracorporeal membrane oxygenation (ECMO) (all P <.01). In CHD and non-CHD cohorts, the only 1-year mortality predictors included: low donor-to-recipient BMI ratio (compared to normal) (odds ratio [OR], 1.70 vs OR, 2.78); presence of liver dysfunction (OR, 1.10 vs OR, 1.11); and use of ECMO (OR, 3.97 vs OR, 3.24). Worse long-term survival was also noted in the non-CHD cohort for those with a low BMI ratio. Neither weight nor BSA predicted 1-year or long-term survival.

“Traditional matching practice using weight may be inadequate and use of BMI matching may provide improved donor-recipient matching,” the study authors noted. “Use of low BMI donors compared to recipient may predict poor early and long-term survival and therefore should be avoided in pediatric heart transplantation.”


Lowrey L. Influence of BMI in donor-recipient size mismatch in pediatric heart transplantation. Presented at: American College of Cardiology’s 71st1 Annual Scientific Session & Expo; April 2-4, 2022; Washington, DC.

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