Abstract 20369: Hearts of Early Adolescent Pediatric Donors can be safely used in Adults
Introduction: Despite a shortage of donor organs for adults, early adolescent (10 to 14 years) donor hearts (not used for pediatric patients) are seldom used for adults due to concerns for changes in left ventricular mass and hormonal activation during puberty. The outcome of adult transplantation using early adolescent donor hearts has not been studied.
Hypothesis: Early adolescent (10 to 14 years) pediatric donor hearts have good outcomes in adult recipients.
Methods: Of the 42,323 adult (≥18 yr.) heart transplant recipients in UNOS database (1994 to 2015), 35,054 met study criteria. Of these, 33,931 received hearts from adults and 1123 from early adolescent donors. Using propensity scores for ‘early adolescent pediatric donor heart use’, we assembled 944 matched pairs of adult transplants using adult vs. early adolescent pediatric donor, balanced on 30 recipient and donor characteristics. Survival, cardiac allograft vasculopathy (CAV) up to 5 years and primary graft failure (PGF) leading to death or re-transplant up to 90 days post-transplant were compared.
Results: Baseline characteristics for matched cohorts of transplants with early adolescent vs adult donor hearts included recipient age 48.9 vs 48.2 years, female sex 45.4% vs 46.3%, size mismatch by weight 8.3% vs 9.1% or by height 8.5% vs 8.7%, and UNOS 1a at transplant 46.3% vs 46.8%, respectively. There was no difference in 30 day, 1 year, 3 year, and 5 year recipient survival or PGF rates in the two groups using both Cox hazards ratio and Kaplan-Meier analysis (Figure 1 and 2). Of note, adult patients who received early adolescent donor hearts had a trend for less CAV (Cox HR= 0.80, 0.62-1.01, p=0.07).
Conclusions: In this largest analysis to date, we found strong evidence that early adolescent donor hearts, not used for pediatric patients, can be safely transplanted in appropriate adult recipients and have excellent outcomes. This finding should help to expand the donor pool.
Author Disclosures: S. Madan: None. S.R. Patel: None. D. Sims: None. O. Saeed: None. J. Shin: None. D. Goldstein: None. U. Jorde: None.
- © 2016 by American Heart Association, Inc.