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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