Donors' characteristics and impact on outcomes in pediatric heart transplant recipients

Jennifer Conway, Clifford Chin, Mariska Kemna, Michael Burch, Aliessa Barnes, Margaret Tresler, Janet N. Scheel, David C. Naftel, Kimberly Beddow, Tina Allain-Rooney, Anne I. Dipchand

Research output: Contribution to journalArticle

Abstract

Organ availability and acceptability limit pediatric HTx. What characteristics define an unacceptable or high-risk pediatric donor remains unclear. The purpose of this study was to characterize a large cohort of pediatric donors and determine the donor risk factors, including cumulative risk, that affect recipient survival. Data from the PHTS, a prospective multicenter study, were used to examine the impact of donor factors on the outcomes of patients listed <18 yr of age who received a HTx between 1993 and 2009. Donor data were available for 3149 of 3156 HTx (99.8%). Donor cause of death, need for inotropes, or CPR did not affect survival outcomes (p = 0.05). Ischemic time also did not have an impact on overall recipient survival; however, longer ischemic times negatively impacted one-yr post-transplant survival (p < 0.0001). There was no impact of cumulative risk factors on survival (p = 0.8). Although used in a minority of cases, hormonal therapy in the donor positively impacted survival (p = 0.03). In multivariate analysis, the only donor factor associated with decreased survival was smaller donor BSA, the other factors being related to the recipient characteristics. When analyzed by recipient age, there were no donor-related factors that affected survival for those who received a transplant at <6 months of age. Longer ischemic time (p < 0.0001) and greater age difference between the recipient and donor (p = 0.0098) were donor-related factors impacting early-phase survival for recipients who received a graft at ≥10 yr of age. Factors perceived to define a marginal or high-risk pediatric heart donor including inotrope use, CPR and donor cause of death may have less impact on outcomes than previously thought. Longer ischemic times did impact one yr, but not overall survival, and this impact was much greater with older donors. Parameters for accepting a donor heart can potentially be expanded, especially in the infant age group, but strong consideration should always be given to the interaction between ischemic time and donor age.

Original languageEnglish (US)
Pages (from-to)774-781
Number of pages8
JournalPediatric transplantation
Volume17
Issue number8
DOIs
StatePublished - Dec 1 2013

Keywords

  • donor characteristics
  • graft survival
  • heart transplant
  • ischemic time
  • pediatric heart transplant
  • pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Fingerprint Dive into the research topics of 'Donors' characteristics and impact on outcomes in pediatric heart transplant recipients'. Together they form a unique fingerprint.

  • Cite this

    Conway, J., Chin, C., Kemna, M., Burch, M., Barnes, A., Tresler, M., Scheel, J. N., Naftel, D. C., Beddow, K., Allain-Rooney, T., & Dipchand, A. I. (2013). Donors' characteristics and impact on outcomes in pediatric heart transplant recipients. Pediatric transplantation, 17(8), 774-781. https://doi.org/10.1111/petr.12149