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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: jordan.ezekian@sickkids.ca
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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.

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