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Centers for Disease Control "high-risk" donor status does not significantly affect recipient outcome after heart
Raj Sahulee1, Irene D Lytrivi1, Jill J Savla2
1Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
High-risk donor (HRD) grafts did not impact outcomes in pediatric heart transplants. Children receiving HRD grafts showed similar survival and rejection rates compared to standard-risk donor grafts.
Area of Science:
- Pediatric Cardiology
- Transplant Surgery
- Public Health
Background:
- The United Network for Organ Sharing (UNOS) introduced "high-risk donor" (HRD) labeling in 2004 for donors meeting Centers for Disease Control (CDC) infection risk criteria.
- Understanding the utilization and impact of HRD grafts in pediatric heart transplantation is crucial for optimizing organ allocation and patient care.
Purpose of the Study:
- To determine the rate of HRD graft utilization in pediatric heart transplantation.
- To compare patient survival, rejection rates, and length of hospital stay between children receiving HRD grafts and those receiving standard-risk donor (SRD) grafts.
Main Methods:
- A retrospective review of the UNOS database for pediatric heart transplants performed between June 30, 2004, and July 31, 2012.
- Patients under 18 were categorized based on donor risk status (HRD vs. SRD).
- Survival analysis and comparison of pre-discharge rejection episodes and post-transplant length of stay were conducted.
Main Results:
- A total of 2,782 pediatric heart transplants were analyzed; 4.1% (116) utilized CDC HRD grafts.
- Recipients of HRD grafts were older and heavier than SRD recipients (p < 0.001).
- No significant differences were observed in patient survival (p = 0.88), pre-discharge rejection rates (p = 0.81), or length of stay (p = 0.58).
Conclusions:
- The use of CDC HRD grafts in pediatric heart transplantation does not appear to significantly compromise recipient outcomes.
- These findings suggest that HRD grafts can be safely utilized in pediatric heart recipients without adverse effects on survival or rejection.
Background:
In 2004, the United Network for Organ Sharing (UNOS) added the label "high-risk donor" (HRD) for any organ donor who met the Centers for Disease Control (CDC) criteria for high-risk behavior for infection. The aim of this study was to calculate the rate of HRD graft use in heart transplantation in children and determine the differences in outcome from those who received standard-risk donor (SRD) grafts.
Methods:
We reviewed information from the UNOS database regarding transplants performed between June 30, 2004 and July 31, 2012. Heart transplant recipients <18 years old were divided into two groups based on the donor's risk status. Demographic data on donors and recipients were collected. Survival analysis was performed to compare survival based on donor status. We also compared episodes of rejection before hospital discharge and the length of stay after transplantation by donor status.
Results:
During the study period, 2,782 pediatric heart transplantations were performed and 116 (4.1%) patients received a CDC HRD graft. Recipients of HRD grafts were significantly older and heavier than those who received an SRD graft (8.5 vs 6.5 years, p < 0.001 and 35.7 vs 26.9 kg, p < 0.001). There was no difference in patient survival (log rank, p = 0.88) between groups. There was no difference in rejection prior to discharge (17.2 vs 16.4%, p = 0.81) or length of stay after transplantation (26.1 vs 27.6 days, p = 0.58).
Conclusions:
CDC HRD graft status does not appear to significantly affect recipient outcome after heart transplantation in children.
