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Mark J. Russo
Ryan R. Davies
Timothy P. Martens
Faisal H. Cheema
Ralph S. Mosca
Jonathan M. Chen
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J Thorac Cardiovasc Surg 2006;132:1208-1212
© 2006 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Adult-age donors offer acceptable long-term survival to pediatric heart transplant recipients: An analysis of the United Network of Organ Sharing database

Mark J. Russo, MD, MSa,b,*, Ryan R. Davies, MDa, Robert A. Sorabella, BAa, Timothy P. Martens, MDa, Isaac George, MDa, Faisal H. Cheema, MDa, Seema Mital, MDc, Ralph S. Mosca, MDa, Jonathan M. Chen, MDa

a Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
c Division of Cardiology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY
b International Center for Health Outcomes and Innovation Research (InCHOIR), Columbia University, New York, NY.

Received for publication February 8, 2006; revisions received March 23, 2006; accepted for publication April 25, 2006.

* Address for reprints: Yoshifumi Naka, MD, Phd, Division of Cardiothoracic Surgery, New York-Presbyterian Hospital/Columbia, Milstein Hospital Bldg Room 7-435, 177 Fort Washington Ave, New York, NY 10032. (Email: yn33{at}columbia.edu).

OBJECTIVES: A critical shortage of donor organs has caused many centers to use less restrictive donor criteria, including the use of adult-age donors for pediatric recipients. The purpose of this study is (1) to describe the supply of pediatric (0-18 years) heart donors, (2) to explore the relationship between donor age and long-term survival, and (3) to define threshold age ranges associated with decreased long-term survival.

METHODS: The United Network of Organ Sharing provided deidentified patient-level data. Primary analysis focused on 1887 heart transplant recipients aged 9 to 18 years undergoing transplantation from October 1, 1987, to September 25, 2005. Kaplan-Meier analysis and log-rank tests were used in time-to-event analysis. Receiver operating characteristic curves and stratum-specific likelihood ratios were generated to compare survival at various donor age thresholds.

RESULTS: The number of pediatric donors decreased (P < .001) over the study period, particularly from 1993 (n = 640) through 2004 (n = 432). Among recipients aged 9 to 18 years, univariate analysis demonstrated a statistically significant (P < .001) inverse relationship between donor age and survival. Stratum-specific likelihood ratio analysis generated 3 strata for donor age: the low-risk, intermediate-risk, and high-risk groups consisted of donors aged 13 years or younger (n = 611, 32.41%), 14 to 51 years (n = 1258, 66.7%), and 52 years and older (n = 16, 0.85%), respectively. In the low-risk, intermediate-risk, and high-risk groups median survival was 4069 days (11.1 years), 3495 days (9.57 years), and 1197 days (3.28 years), respectively.

CONCLUSIONS: Although donors aged 13 years or less offer pediatric recipients the best chance for achieving long-term survival, donors aged 14 to 51 years offer good outcomes to pediatric recipients. Consideration should be given to expanded use of well-selected adult-age donors for pediatric recipients.

Abbreviations and Acronyms ROC = receiver operating characteristic; SSLR = stratum-specific likelihood ratio; TCAD = transplant coronary artery disease; UNOS = United Network for Organ Sharing




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 J. Thorac. Cardiovasc. Surg.Home page
R. R. Davies, M. J. Russo, S. Mital, T. M. Martens, R. S. Sorabella, K. N. Hong, A. C. Gelijns, A. J. Moskowitz, J. M. Quaegebeur, R. S. Mosca, et al.
Predicting survival among high-risk pediatric cardiac transplant recipients: An analysis of the United Network for Organ Sharing database
J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 147 - 155.
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