Abstract 2119: Pediatric Cardiac Graft Survival is Reduced When Donors Are Over 30 years Old
Objective When patients are listed for pediatric heart transplant an age range for acceptable donors is submitted. Institutions usually have standard range for ages depending on the recipient’s age. It is unclear that age restriction is necessary. Therefore, the UNOS database was analyzed to determine if age differences between donor and recipient or any specific donor age effects graft survival.
Methods The UNOS database for thoracic organ transplantation (May 1988 – May 2008) contains the records of 5423 pediatric (age <18yo) heart transplants. The 5403 (99%) pediatric heart transplants that had donor and recipient ages were the cohort analyzed. Median age and weight for recipient and donor was 4yrs (0 –17yrs)/16kgs (1–173kg) and 5yrs (0 –59yrs)/21kgs (1–157kg) respectively.
Results Donor to recipient age ratio (mean:1.3 ± 0.9) was >1 in 2222 (41%), 1 in 2088 (39%) and <1 in 1093 (20%) transplants. Graft survival was not significantly different between these groups. Analysis of donor to recipient age difference by yearly increments and decrements up to a 10 year difference demonstrated no effect on Kaplan-Meier graft survival. When examined in age subgroups [Infants [1644 (30%)], 2–10yrs [1938 (36%)] and 11–18yrs [1821 (34%)], there were no significant differences. When examined for different diagnoses (i.e. restrictive cardiomyopathy, dilated cardiomyopathy, end-stage congenital heart disease), there were no significant differences. Graft survival from donors 30 – 40 years-old was significantly worse compared to survival with donors <20 yo (p = 0.002). Graft survival worsens even more with donor ages >40 (p < 0.0001). Adolescents with a donor 30 – 40 yo [187 (10%)] also showed worse graft survival than with a donor <20 yo [1159 (64)] (p=0.05).
Conclusion Regardless of recipient age or diagnosis, differences in donor and recipient age did not effect graft survival. However, accepting a heart from a donor over 30 years old for a pediatric recipient reduces graft survival.