August 01, 2014
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High-risk donor status did not affect pediatric heart transplant outcomes

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Children who received transplanted hearts from high infectious-risk donors had no differences in outcomes compared with children who received hearts from donors at standard infectious risk, according to new findings.

In addition, there was a trend toward shorter time on the waitlist for children who received high-risk grafts compared with those who received standard-risk grafts, Raj Sahulee, DO, assistant professor of pediatrics at Icahn School of Medicine at Mount Sinai, reported at Cardiology 2014, the 17th annual update on pediatric and congenital CVD. The data were subsequently published in The Journal of Heart and Lung Transplantation.

“There is in fact no such thing as zero risk for infectious pathogen transmission through transplantation,” Sahulee told Cardiology Today. “These data show that, although the risk [of infection from high-risk grafts] is present, the overall risk is low, the outcomes are the same [as with standard-risk grafts], and those potential outcomes should be weighed with the potential outcomes of not being transplanted with a high-risk donor graft.”

Refusal of donor hearts

The United Network for Organ Sharing (UNOS) in 2004 began labeling any organ donor who met CDC criteria for high infectious disease behavior as high risk. This led to reports of refusal by some families and doctors to accept donor hearts labeled high risk, according to the study background.

Sahulee and colleagues reviewed the UNOS database to investigate differences in outcomes between children who received high-risk grafts and those who received standard-risk grafts from June 2004 to July 2012.

“To date, no study in any pediatric transplant literature had looked at the outcome difference for CDC high-risk donor grafts,” Sahulee told Cardiology Today. “Ours was the first study to look at the percentage of heart transplants in pediatrics that use high-risk donor grafts, and it was one of a limited number of overall studies and the first pediatric study to look specifically at differences in survival and outcome.”

The primary outcomes were patient survival and graft survival. Secondary outcomes included differences in waitlist times and short-term morbidities after transplantation.

Of 2,782 pediatric heart transplants performed during the study period, 4.1% involved a high-risk donor graft. Patients receiving high-risk grafts were older on average than those receiving standard-risk grafts (8.5 years vs. 6.5 years; P<.01), but there was no difference in sex (53.4% girls vs. 45.8% girls, P=.1), the researchers found.

No difference in survival

Results also demonstrated no difference between the groups in patient survival (log rank P=.88) or graft survival (log rank P=.89).

The researchers observed a trend toward shorter mean waitlist time for those with high-risk grafts compared with those with standard-risk grafts (59.5 days vs. 98.3 days; P=.06).

In addition, there was no difference in episodes of rejection prior to discharge (high-risk group, 17.2%; standard-risk group, 16.4%; P=.81) or in length of stay after transplantation (high-risk group, 27.6 days; standard-risk group, 26.1 days; P=.58).

Because additional informed consent is required to receive a CDC high-risk graft, “in experience, this has led to refusal of otherwise high quality grafts by patients, families and even physicians themselves,” Sahulee said in an interview. “Some institutions have a widespread policy against using high-risk donor grafts altogether. But [the findings are] information that a transplant physician can use when speaking to a potential transplant recipient when describing the risks and benefits of receiving transplantation with high-risk donor grafts.” – by Erik Swain

For more information:

Sahulee R. Abstract 624. Presented at: Cardiology 2014, the 17th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 19-23, 2014; Lake Buena Vista, Fla.

Sahulee R. J Heart Lung Transplant. 2014;33:S225-S226.

Disclosure: UNOS is funded by the Department of Health and Human Services. Sahulee reports no relevant financial disclosures.