Article Text

  1. M. J. Saran,
  2. W. Yao,
  3. D. Gjertson,
  4. J. Kobashigawa,
  5. H. Laks,
  6. J. Odim
  1. Los Angeles, CA.


Background We sought to test the hypothesis that older donor cardiac allografts in pediatric recipients had worse outcomes. Methods: Medical records of 207 consecutive heart transplants in 190 patients were reviewed. Donor allografts were divided into three groups by age. Analysis was limited to recipients between 10-21 yrs due to few children 0-9 yrs receiving grafts from donors ≥ 18 yrs of age. Recipients were stratified into low and high-risk categories, the latter bearing one or more of: CHD diagnosis, re-transplant, ventilator or mechanical circulatory assist dependency. Study endpoints were survival and freedom from rejection. Statistical analysis employed a Cox proportional hazards model with donor age 0-18 yrs as baseline. (Table)

Results One and 3-yr actuarial survival for low-risk adolescents was 100 and 81%; and high-risk was 80 and 65%. One-year freedom from acute rejection for low-risk and high-risk patients was 58 and 78%. In the high-risk category alone, there was a trend towards lower 30-day mortality (0 vs. 17%, p=0.12) in Group 2. One year post-transplant, Group 2 had higher graft survival (96 vs. 66%, p=0.03) and a trend toward less rejection (87 vs. 68%, p=0.3). Freedom from the composite endpoint of graft failure, rejection, or death at 1 year was 35%, 85% and 58% for Groups 1, 2, and 3 respectively (p=0.01).

Conclusion Adolescents had better outcomes with allografts from donors 18-36 yrs than less than 18 yrs. The results support use of older donor allografts in patients in their second decade of life given critical organ supply shortages.

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