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The use of advanced-age donor hearts adversely affects survival in pediatric heart transplantation
1Department of Pediatrics and Cardiovascular Surgery, Stanford University, California, USA.
Insights
Using donor hearts from individuals over 40 years old significantly reduces survival rates in pediatric heart transplant recipients. Advanced-age donor hearts are generally not recommended for children due to higher risks of graft failure and rejection.
Area of Science:
- Cardiology
- Transplantation Medicine
- Pediatric Surgery
Background:
- Limited availability of suitable donor hearts for cardiac transplantation.
- Safety of utilizing advanced-age donor hearts is debated in adults but unstudied in pediatric recipients.
Observation:
- Retrospective study of 79 pediatric heart transplant recipients stratified by donor age (>40 vs. <=40 years).
- Analysis of 267 adolescent recipients from the United Network for Organ Sharing (UNOS) database, also stratified by donor age.
Findings:
- One-year survival was significantly lower (20%) for pediatric recipients receiving hearts from donors >40 years compared to those receiving hearts from younger donors (78%).
- Graft failure due to acute rejection was the primary cause of death in the advanced-age donor group.
- UNOS data corroborated findings, showing significantly lower one- and two-year survival rates for adolescent recipients of older donor hearts.
Implications:
- Advanced-age donor hearts should be contraindicated in pediatric cardiac transplantation.
- Exception: Critically ill pediatric patients who face prolonged waiting times for a younger donor heart may be considered.
- This research highlights the critical impact of donor age on pediatric heart transplant outcomes.
Abstract:
There is a limited supply of adequate donor hearts for cardiac transplantation. The safety of using advanced-age donor hearts has been debated in adult transplantation but has not been studied previously in pediatric recipients. In this retrospective study, survival of 79 pediatric heart transplant recipients was reviewed. Pediatric recipient groups were stratified based on donor age (group 1 donor age > 40 yr, n = 5; group 2 donor age < or = 40 yr, n = 74). Survival of 267 adolescent (ages 11-17) heart transplant recipients in the United Network for Organ Sharing (UNOS) database was also reviewed. Patients were likewise divided into two groups based on donor age (> 40 yr, n = 12; < or = 40 yr, n = 255). Survival at one yr was 20% in group 1 vs. 78% in group 2 (p < 0.005). Cause of death in all group 1 patients was graft failure secondary to acute rejection. Analysis of risk of death was only significantly attributable to the age of the donor. The increased risk attributable to advanced donor age was also supported by the UNOS data. The UNOS one and two-year Kaplan-Meier survival curves were significantly lower in adolescent patients who received donor hearts > 40 yr of age. One-year survival was 58% (older donors) vs. 85% (younger donors, p < 0.005) and two-year survival was 44% (older donors) vs. 79% (younger donors, p < 0.005). Advanced-age donor hearts should be contraindicated in pediatric transplantation with the exception of critically ill patients who may not be able to wait for a younger heart.