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Decline of increased risk donor offers increases waitlist mortality in paediatric heart transplantation

Published online by Cambridge University Press:  25 August 2021

Jordan E. Ezekian ,
Michael S. Mulvihill ,
Brian Ezekian ,
Morgan L. Cox ,
Sonya Kirmani  and
Kevin D. Hill Open the ORCID record for Kevin D. Hill [Opens in a new window]
Jordan E. Ezekian*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada
Michael S. Mulvihill
Affiliation:
Department of Surgery, Duke University Medical Center, Durham, NC, USA
Brian Ezekian
Affiliation:
Department of Surgery, Duke University Medical Center, Durham, NC, USA
Morgan L. Cox
Affiliation:
Department of Surgery, Duke University Medical Center, Durham, NC, USA
Sonya Kirmani
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
Kevin D. Hill
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
*
Author for correspondence: J. E. Ezekian, MD MPH, The Hospital for Sick Children, 555 University Ave, TorontoM5G1X8, Canada. Tel: 919-668-4745; Fax: 919-681-8927. E-mail: [email protected]
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Abstract

Background:

Increased risk donors in paediatric heart transplantation have characteristics that may increase the risk of infectious disease transmission despite negative serologic testing. However, the risk of disease transmission is low, and refusing an IRD offer may increase waitlist mortality. We sought to determine the risks of declining an initial IRD organ offer.

Methods and results:

We performed a retrospective analysis of candidates waitlisted for isolated PHT using 20072017 United Network of Organ Sharing datasets. Match runs identified candidates receiving IRD offers. Competing risks analysis was used to determine mortality risk for those that declined an initial IRD offer with stratified Cox regression to estimate the survival benefit associated with accepting initial IRD offers. Overall, 238/1067 (22.3%) initial IRD offers were accepted. Candidates accepting an IRD offer were younger (7.2 versus 9.8 years, p < 0.001), more often female (50 versus 41%, p = 0.021), more often listed status 1A (75.6 versus 61.9%, p < 0.001), and less likely to require mechanical bridge to PHT (16% versus 23%, p = 0.036). At 1- and 5-year follow-up, cumulative mortality was significantly lower for candidates who accepted compared to those that declined (6% versus 13% 1-year mortality and 15% versus 25% 5-year mortality, p = 0.0033). Decline of an IRD offer was associated with an adjusted hazard ratio for mortality of 1.87 (95% CI 1.24, 2.81, p < 0.003).

Conclusions:

IRD organ acceptance is associated with a substantial survival benefit. Increasing acceptance of IRD organs may provide a targetable opportunity to decrease waitlist mortality in PHT.

Keywords

Heart transplantincreased risk donormortality
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 8 , August 2021 , pp. 1228 - 1237
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Jordan E. Ezekian and Michael S. Mulvihill equally contributored to this article.

References

Goldfarb, SB, Levvey, BJ, Edwards, LB, et al. The registry of the international society for heart and lung transplantation: nineteenth pediatric lung and heart-Lung transplantation Report-2016; focus theme: primary diagnostic indications for transplant. J Heart Lung Transplant 2016; 35: 1196–1205.CrossRefGoogle ScholarPubMed
Almond, CSD, Thiagarajan, RR, Piercey, GE, et al. Waiting list mortality among children listed for heart transplantation in the US. Circulation 2009; 119: 717–727.CrossRefGoogle Scholar
Dipchand, AI, Kirk, R, Naftel, DC, et al. Ventricular assist device support as a bridge to transplantation in pediatric patients. J Am Coll Cardiol 2018; 72: 402–415.CrossRefGoogle ScholarPubMed
Zafar, F, Castleberry, C, Khan, MS, et al. Pediatric heart transplant waiting list mortality in the era of ventricular assist devices. J Heart Lung Transplant 2015; 34: 82–88.CrossRefGoogle ScholarPubMed
OPTN. US Department of Health and Human Services. Organ Procurement and Transplantation Network Policies. 2019, 248. Retrieved 6 June 2020 from https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf.Google Scholar
OPTN. US Department of Health and Human Services. Understanding HIV HBV HCV risks from increased risk donors 2017, 1–9. Retrieved 6 June 2020 from https://optn.transplant.hrsa.gov/media/2270/dtac_guidance_risks_201706.pdf.Google Scholar
Bowring, MG, Holscher, CM, Zhou, S, et al. Turn down for what? patient outcomes associated with declining increased infectious risk kidneys. Am J Transplant 2018; 18: 617–624.CrossRefGoogle ScholarPubMed
Gaffey, AC, Doll, SL, Thomasson, AM, et al. Transplantation of “high-risk” donor hearts: implications for infection. J Thorac Cardiovasc Surg 2016; 152: 213–220.CrossRefGoogle ScholarPubMed
Mehta, V, Chou, PC, Picken, MM. Adenovirus disease in six small bowel, kidney and heart transplant recipients; pathology and clinical outcome. Virchows Arch 2015; 467: 603–608.CrossRefGoogle ScholarPubMed
Green, M, Covington, S, Taranto, S, Michaels, MG, Wolfe, C, Kaul, DR. Pediatrics and donor-derived disease transmission: the US OPTN experience. Pediatr Transplant 2018; 22: e13115.CrossRefGoogle ScholarPubMed
Volk, ML, Wilk, AR, Wolfe, C, Kaul, DR. The “PHS Increased Risk” label is associated with nonutilization of hundreds of organs per year. Transplantation 2017; 101: 1666–1669.CrossRefGoogle ScholarPubMed
Khan, AM, Green, RS, Lytrivi, ID, Sahulee, R. Donor predictors of allograft utilization for pediatric heart transplantation. Transplant International 2016; 26: 1269–1275.CrossRefGoogle Scholar
Seem, DL, Lee, I, Umscheid, CA, Kuehnert, MJ. PHS guideline for reducing human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission through organ transplantation. Public Health Reports 2013; 128: 247–304.CrossRefGoogle ScholarPubMed
Kucirka, LM, Bowring, MG, Massie, AB, Luo, X, Nicholas, LH, Segev, DL. Landscape of deceased donors labeled increased risk for disease transmission under new guidelines. Am J Transplant 2015; 15: 3215–3223.CrossRefGoogle ScholarPubMed
Moayedi, Y, Ross, HJ, Khush, KK. Disclosure of infectious risk to heart transplant candidates: shared decision-making is here to stay. J Heart Lung Transplant 2018; 37: 564–567.CrossRefGoogle Scholar
Pruett, TL, Clark, MA, Taranto, SE. Deceased organ donors and PHS risk identification: impact on organ usage and outcomes. Transplantation 2017; 101: 1670–1678.CrossRefGoogle ScholarPubMed
Sahulee, R, Lytrivi, ID, Savla, JJ, Rossano, JW. Centers for disease control “high-risk” donor status does not significantly affect recipient outcome after heart transplantation in children. J Heart Lung Transplant 2014; 33: 1173–1177.CrossRefGoogle Scholar
Davies, RR, Bano, M, Butts, RJ, Jaquiss, RDB, Kirk, R. Donor organ turn-downs and outcomes after listing for pediatric heart transplant. J Heart Lung Transplant 2019; 38: 241–251.CrossRefGoogle ScholarPubMed
Feingold, B. The challenges of donor-derived risk, donor shortage and waitlist mortality in children: time for a new measuring stick? J Heart Lung Transplant 2018; 37: 317–318.CrossRefGoogle ScholarPubMed
Conway, J, Chin, C, Kemna, M, et al. Donorsʼ characteristics and impact on outcomes in pediatric heart transplant recipients. Pediatr Transplant 2013; 17: 774–781.CrossRefGoogle ScholarPubMed
Rossano, JW, Lin, KY, Paridon, SM, et al. Pediatric heart transplantation from donors with depressed ventricular function: an analysis of the united network of organ sharing database. Circ Heart Fail 2013; 6: 1223–1229.CrossRefGoogle ScholarPubMed
Davies, RR, Pizarro, C. Using the UNOS/SRTR and PHTS databases to improve quality in pediatric cardiac transplantation. World J Pediatr Congenit Heart Surg 2012; 3: 421–432.CrossRefGoogle ScholarPubMed
Baran, DA, Copeland, H, Copeland, J. What Number Are We? ircul Heart Failure 2019; 12:e005823.CrossRefGoogle Scholar
McGiffin, DC, Naftel, DC, Kirklin, JK, et al. Predicting outcome after listing for heart transplantation in children: comparison of Kaplan-Meier and parametric competing risk analysis. Pediatric Heart Transplant Study Group.. J Heart Lung Transplant 1997; 16: 713–722.Google ScholarPubMed
Collett, D. Modelling Survival Data in Medical Research. Chapman & Hall, London, 1994.CrossRefGoogle Scholar
Rizwan, R, Zafar, F, Bryant, R, et al. The number of refusals for donor organ quality does not impact heart transplant outcomes in children. Ann Thoracic Surg 2018; 105: 1223–1230.CrossRefGoogle Scholar
Park, CS, Villa, CR, Lorts, A, et al. Is there an optimal organ acceptance rate for pediatric heart transplantation: “a sweet spot"? Pediatr Transplant 2018; 22: e13149.CrossRefGoogle ScholarPubMed
Andrews, WS, Kane, BJ, Hendrickson, RJ. Organ allocation and utilization in pediatric transplantation. Semin Pediatr Surg 2017; 26: 186–192.CrossRefGoogle ScholarPubMed
Jeewa, A, Manlhiot, C, Kantor, PF, Mital, S, McCrindle, BW, Dipchand, AI. Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list. J Thorac Cardiovasc Surg 2014; 147: 462–468.CrossRefGoogle ScholarPubMed
Morrison, AK, Gowda, C, Tumin, D, et al. Pediatric marginal donor hearts: trends in US national use, 2005-2014. Pediatr Transplant 2018; 22: e13216.CrossRefGoogle ScholarPubMed
Webber, S, Zeevi, A, Mason, K, et al. Pediatric heart transplantation across a positive crossmatch: first year results from the CTOTC-04 multi-institutional study. Am J Transplant 2018; 18: 2148–2162.CrossRefGoogle ScholarPubMed
Mahle, WT, Fourshee, MT, Naftel, DM, Alejos, JC, Caldwell, RL, Uzark, K, Berg, A, Kanter, KR, Group TPHTS. Does cytomegalovirus serology impact outcome after pediatric heart transplantation? J Heart Lung Transplant 2009; 28: 1299–1305.CrossRefGoogle ScholarPubMed
Cox, ML, Mulvihill, MS, Choi, AY, et al. Implications of declining donor offers with increased risk of disease transmission on waiting list survival in lung transplantation. J Heart Lung Transplant 2019; 38: 295–305.CrossRefGoogle ScholarPubMed
Mulvihill, MS, Cox, ML, Bishawi, M, et al. Decline of increased risk donor offers on waitlist survival in heart transplantation. J Am Coll Cardiol 2018; 72: 2408–2409.CrossRefGoogle ScholarPubMed
Singh, E, Schecter, M, Towe, C, et al. Sequence of refusals for donor quality, organ utilization, and survival after lung transplantation. J Heart Lung Transplant 2019; 38: 35–42.CrossRefGoogle ScholarPubMed
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