Skip to main content
Journal cover image

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

Publication ,  Journal Article
Ezekian, JE; Mulvihill, MS; Ezekian, B; Cox, ML; Kirmani, S; Hill, KD
Published in: Cardiol Young
August 2021

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.

Duke Scholars

Published In

Cardiol Young

DOI

EISSN

1467-1107

Publication Date

August 2021

Volume

31

Issue

8

Start / End Page

1228 / 1237

Location

England

Related Subject Headings

  • Transplant Recipients
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Humans
  • Heart Transplantation
  • Female
  • Donor Selection
  • Child
  • Cardiovascular System & Hematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ezekian, J. E., Mulvihill, M. S., Ezekian, B., Cox, M. L., Kirmani, S., & Hill, K. D. (2021). Decline of increased risk donor offers increases waitlist mortality in paediatric heart transplantation. Cardiol Young, 31(8), 1228–1237. https://doi.org/10.1017/S104795112100353X
Ezekian, Jordan E., Michael S. Mulvihill, Brian Ezekian, Morgan L. Cox, Sonya Kirmani, and Kevin D. Hill. “Decline of increased risk donor offers increases waitlist mortality in paediatric heart transplantation.Cardiol Young 31, no. 8 (August 2021): 1228–37. https://doi.org/10.1017/S104795112100353X.
Ezekian JE, Mulvihill MS, Ezekian B, Cox ML, Kirmani S, Hill KD. Decline of increased risk donor offers increases waitlist mortality in paediatric heart transplantation. Cardiol Young. 2021 Aug;31(8):1228–37.
Ezekian, Jordan E., et al. “Decline of increased risk donor offers increases waitlist mortality in paediatric heart transplantation.Cardiol Young, vol. 31, no. 8, Aug. 2021, pp. 1228–37. Pubmed, doi:10.1017/S104795112100353X.
Ezekian JE, Mulvihill MS, Ezekian B, Cox ML, Kirmani S, Hill KD. Decline of increased risk donor offers increases waitlist mortality in paediatric heart transplantation. Cardiol Young. 2021 Aug;31(8):1228–1237.
Journal cover image

Published In

Cardiol Young

DOI

EISSN

1467-1107

Publication Date

August 2021

Volume

31

Issue

8

Start / End Page

1228 / 1237

Location

England

Related Subject Headings

  • Transplant Recipients
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Humans
  • Heart Transplantation
  • Female
  • Donor Selection
  • Child
  • Cardiovascular System & Hematology