ArticleClinical transplantation2026
Utility of Right Ventricular Mass Ratios in Recipients With Pulmonary Hypertension: A United Network for Organ-Sharing Database Analysis.
Article in Clinical transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThere is a lack of data reviewing the role of predicted cardiac mass ratio (PCMR) in transplant recipients with pulmonary hypertension (PH). In particular, the right ventricular (RV) mass ratio (RVMR) is a component of PCMR not yet studied separately for this purpose. We aimed to review the relationship of PCMR and RVMR with PH in terms of post-transplant overall survival.
methodsThe United Network for Organ-Sharing (UNOS) database was queried for primary heart transplant (HTx) patients from 2004 to 2023. Predicted RVMR was calculated for donors and recipients. A parsimonious multivariable model Cox model was formed for risk adjustment. Covariates with statistically significant relationships to the outcomes were further evaluated with tensor product spline models.
resultsA total of 37 904 patients were identified. After risk adjustment, diastolic pulmonary artery pressure (dPAP) was protective (HR 0.993 [0.989-0.997], p = 0.001), whereas increasing systolic pulmonary artery pressures (sPAPs) (HR 1.007 [1.005-1.009], p < 0.001) and diastolic pulmonary gradient (DPG) (HR 1.011 [1.007-1.015], p < 0.001) were associated with increased overall mortality. Increasing RV mass ratio (RVMR) was protective (OR 0.663 [0.589-0.747], p < 0.001)). This was appreciated in a restricted cubic spline analysis as a nonlinear relation was evident with any RVMR less than 1 (p < 0.001). Subsequent tensor product spline models evaluating the complex relationship between RVMR and pulmonary pressures demonstrated increasing relative hazards in patients with PH and smaller RVMR (p < 0.001).
conclusionIn HTx patients with PH, RVMR ≥ 1 is significantly associated with a reduced hazard of overall mortality. This indicates RV undersizing may be harmful in the population.
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