Outcomes of Early Adolescent Donor Hearts in Adult Transplant Recipients

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: This study sought to determine outcomes of adult recipients of early adolescent (EA) (10 to 14 years) donor hearts. Background: Despite a shortage of donor organs, EA donor hearts (not used for pediatric patients) are seldom used for adults because of theoretical concerns for lack of hormonal activation and changes in left ventricular mass. Nonetheless, the outcomes of adult transplantation using EA donor hearts are not clearly established. Methods: All adult (≥18 years of age) heart transplant recipients in the United Network for Organ Sharing database between April 1994 and September 2015 were eligible for this analysis. Recipients of EA donor hearts were compared with recipients of donor hearts from the usual adult age group (ages 18 to 55 years). Main outcomes were all-cause mortality and cardiac allograft vasculopathy up to 5 years, and primary graft failure up to 90 days post-transplant. Propensity score analysis was used to identify a cohort of recipients with similar baseline characteristics. Results: Of the 35,054 eligible adult recipients, 1,123 received hearts from EA donors and 33,931 from usual-age adult donors. With the use of propensity score matching, 944 recipients of EA donor hearts were matched to 944 recipients of usual-age adult donor hearts. There was no difference in 30-day, 1-year, 3-year, and 5-year recipient survival or primary graft failure rates in the 2 groups using both Cox hazards ratio and Kaplan-Meier analysis. Of note, adult patients who received EA donor hearts had a trend toward less cardiac allograft vasculopathy (Cox hazard ratio, 0.80; 95% confidence interval: 0.62 to 1.01; p = 0.07). Conclusions: In this largest analysis to date, we found strong evidence that EA donor hearts, not used for pediatric patients, can be safely transplanted in appropriate adult patients and have good outcomes. This finding should help increase the use of EA donor hearts.

Original languageEnglish (US)
JournalJACC: Heart Failure
DOIs
StateAccepted/In press - 2017

Fingerprint

Tissue Donors
Propensity Score
Transplants
Transplant Recipients
Allografts
Pediatrics
Kaplan-Meier Estimate
Age Groups
Transplantation
Databases
Confidence Intervals
Survival
Mortality

Keywords

  • Donor
  • Donor age
  • Early adolescent
  • Heart
  • Transplant

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{cba417fbd2d245a091b974abc58f3c60,
title = "Outcomes of Early Adolescent Donor Hearts in Adult Transplant Recipients",
abstract = "Objectives: This study sought to determine outcomes of adult recipients of early adolescent (EA) (10 to 14 years) donor hearts. Background: Despite a shortage of donor organs, EA donor hearts (not used for pediatric patients) are seldom used for adults because of theoretical concerns for lack of hormonal activation and changes in left ventricular mass. Nonetheless, the outcomes of adult transplantation using EA donor hearts are not clearly established. Methods: All adult (≥18 years of age) heart transplant recipients in the United Network for Organ Sharing database between April 1994 and September 2015 were eligible for this analysis. Recipients of EA donor hearts were compared with recipients of donor hearts from the usual adult age group (ages 18 to 55 years). Main outcomes were all-cause mortality and cardiac allograft vasculopathy up to 5 years, and primary graft failure up to 90 days post-transplant. Propensity score analysis was used to identify a cohort of recipients with similar baseline characteristics. Results: Of the 35,054 eligible adult recipients, 1,123 received hearts from EA donors and 33,931 from usual-age adult donors. With the use of propensity score matching, 944 recipients of EA donor hearts were matched to 944 recipients of usual-age adult donor hearts. There was no difference in 30-day, 1-year, 3-year, and 5-year recipient survival or primary graft failure rates in the 2 groups using both Cox hazards ratio and Kaplan-Meier analysis. Of note, adult patients who received EA donor hearts had a trend toward less cardiac allograft vasculopathy (Cox hazard ratio, 0.80; 95{\%} confidence interval: 0.62 to 1.01; p = 0.07). Conclusions: In this largest analysis to date, we found strong evidence that EA donor hearts, not used for pediatric patients, can be safely transplanted in appropriate adult patients and have good outcomes. This finding should help increase the use of EA donor hearts.",
keywords = "Donor, Donor age, Early adolescent, Heart, Transplant",
author = "Shivank Madan and Patel, {Snehal R.} and Peter Vlismas and Omar Saeed and Sandhya Murthy and Forest, {Stephen J.} and Jakobleff, {William A.} and Sims, {Daniel B.} and Lamour, {Jacqueline M.} and Hsu, {Daphne T.} and Shin, {Jooyoung (Julia)} and Goldstein, {Daniel J.} and Jorde, {Ulrich P.}",
year = "2017",
doi = "10.1016/j.jchf.2017.05.004",
language = "English (US)",
journal = "JACC: Heart Failure",
issn = "2213-1779",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Outcomes of Early Adolescent Donor Hearts in Adult Transplant Recipients

AU - Madan, Shivank

AU - Patel, Snehal R.

AU - Vlismas, Peter

AU - Saeed, Omar

AU - Murthy, Sandhya

AU - Forest, Stephen J.

AU - Jakobleff, William A.

AU - Sims, Daniel B.

AU - Lamour, Jacqueline M.

AU - Hsu, Daphne T.

AU - Shin, Jooyoung (Julia)

AU - Goldstein, Daniel J.

AU - Jorde, Ulrich P.

PY - 2017

Y1 - 2017

N2 - Objectives: This study sought to determine outcomes of adult recipients of early adolescent (EA) (10 to 14 years) donor hearts. Background: Despite a shortage of donor organs, EA donor hearts (not used for pediatric patients) are seldom used for adults because of theoretical concerns for lack of hormonal activation and changes in left ventricular mass. Nonetheless, the outcomes of adult transplantation using EA donor hearts are not clearly established. Methods: All adult (≥18 years of age) heart transplant recipients in the United Network for Organ Sharing database between April 1994 and September 2015 were eligible for this analysis. Recipients of EA donor hearts were compared with recipients of donor hearts from the usual adult age group (ages 18 to 55 years). Main outcomes were all-cause mortality and cardiac allograft vasculopathy up to 5 years, and primary graft failure up to 90 days post-transplant. Propensity score analysis was used to identify a cohort of recipients with similar baseline characteristics. Results: Of the 35,054 eligible adult recipients, 1,123 received hearts from EA donors and 33,931 from usual-age adult donors. With the use of propensity score matching, 944 recipients of EA donor hearts were matched to 944 recipients of usual-age adult donor hearts. There was no difference in 30-day, 1-year, 3-year, and 5-year recipient survival or primary graft failure rates in the 2 groups using both Cox hazards ratio and Kaplan-Meier analysis. Of note, adult patients who received EA donor hearts had a trend toward less cardiac allograft vasculopathy (Cox hazard ratio, 0.80; 95% confidence interval: 0.62 to 1.01; p = 0.07). Conclusions: In this largest analysis to date, we found strong evidence that EA donor hearts, not used for pediatric patients, can be safely transplanted in appropriate adult patients and have good outcomes. This finding should help increase the use of EA donor hearts.

AB - Objectives: This study sought to determine outcomes of adult recipients of early adolescent (EA) (10 to 14 years) donor hearts. Background: Despite a shortage of donor organs, EA donor hearts (not used for pediatric patients) are seldom used for adults because of theoretical concerns for lack of hormonal activation and changes in left ventricular mass. Nonetheless, the outcomes of adult transplantation using EA donor hearts are not clearly established. Methods: All adult (≥18 years of age) heart transplant recipients in the United Network for Organ Sharing database between April 1994 and September 2015 were eligible for this analysis. Recipients of EA donor hearts were compared with recipients of donor hearts from the usual adult age group (ages 18 to 55 years). Main outcomes were all-cause mortality and cardiac allograft vasculopathy up to 5 years, and primary graft failure up to 90 days post-transplant. Propensity score analysis was used to identify a cohort of recipients with similar baseline characteristics. Results: Of the 35,054 eligible adult recipients, 1,123 received hearts from EA donors and 33,931 from usual-age adult donors. With the use of propensity score matching, 944 recipients of EA donor hearts were matched to 944 recipients of usual-age adult donor hearts. There was no difference in 30-day, 1-year, 3-year, and 5-year recipient survival or primary graft failure rates in the 2 groups using both Cox hazards ratio and Kaplan-Meier analysis. Of note, adult patients who received EA donor hearts had a trend toward less cardiac allograft vasculopathy (Cox hazard ratio, 0.80; 95% confidence interval: 0.62 to 1.01; p = 0.07). Conclusions: In this largest analysis to date, we found strong evidence that EA donor hearts, not used for pediatric patients, can be safely transplanted in appropriate adult patients and have good outcomes. This finding should help increase the use of EA donor hearts.

KW - Donor

KW - Donor age

KW - Early adolescent

KW - Heart

KW - Transplant

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U2 - 10.1016/j.jchf.2017.05.004

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JF - JACC: Heart Failure

SN - 2213-1779

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