Donor organ turn-downs and outcomes after listing for pediatric heart transplant

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3 Citations (Scopus)

Abstract

BACKGROUND: Pediatric heart transplant waitlist mortality remains significant but allograft offer refusals are common and allografts continue to be discarded. Our aim in this study was to assess the impact of donor organ refusals on mortality after listing using a multi-institutional data set. METHODS: In this study we conducted a retrospective review of donor offers made to pediatric (<18 years) recipients in the United States in the period from 2007 to 2017. Candidates were stratified by whether they refused an acceptable donor offer (ADO). Acceptance was defined as an offer from a donor <40 years old and within 1,000 miles that was ultimately accepted by a waitlist candidate. Candidate survival after an offer was assessed. RESULTS: There were 12,447 hearts offered at least once to a pediatric candidate. Most candidates (n = 4,282, 84.4%) refused the first offer, and 677 (15.4%) of these subsequently died or were removed from the list for deterioration. Refusal of an ADO was associated with higher mortality after listing, independent of transplant, in both univariate (1 year: 92% vs 87%, p = 0.002) and multivariate (hazard ratio 1.5, 95% CI 1.2 to 1.7, p < 0.0001) Cox regression analyses. ADO refusals were not correlated with improved post-transplant survival and >8 ADO refusals was associated with higher risk-adjusted post-transplant mortality (odds ratio 1.7, 95% confidence interval 1.0 to 2.9, p = 0.04). CONCLUSIONS: Refusal of ADOs is associated with higher risk-adjusted mortality after listing (independent of transplantation), without improvement in post-transplant outcomes. So, although a “perfect” organ would be ideal, acceptance of one that is “good enough” has the potential to improve survival among pediatric candidates for heart transplantation.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Tissue Donors
Pediatrics
Transplants
Mortality
Allografts
Heart Transplantation
Transplantation
Odds Ratio
Confidence Intervals
Survival
beta-apocarotenoid-14',13'-dioxygenase
Datasets

Keywords

  • donor organ refusals
  • heart transplant
  • pediatrics
  • post-transplant outcomes
  • waitlist mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

@article{cc6190284649410aaaaf420beb35aa6b,
title = "Donor organ turn-downs and outcomes after listing for pediatric heart transplant",
abstract = "BACKGROUND: Pediatric heart transplant waitlist mortality remains significant but allograft offer refusals are common and allografts continue to be discarded. Our aim in this study was to assess the impact of donor organ refusals on mortality after listing using a multi-institutional data set. METHODS: In this study we conducted a retrospective review of donor offers made to pediatric (<18 years) recipients in the United States in the period from 2007 to 2017. Candidates were stratified by whether they refused an acceptable donor offer (ADO). Acceptance was defined as an offer from a donor <40 years old and within 1,000 miles that was ultimately accepted by a waitlist candidate. Candidate survival after an offer was assessed. RESULTS: There were 12,447 hearts offered at least once to a pediatric candidate. Most candidates (n = 4,282, 84.4{\%}) refused the first offer, and 677 (15.4{\%}) of these subsequently died or were removed from the list for deterioration. Refusal of an ADO was associated with higher mortality after listing, independent of transplant, in both univariate (1 year: 92{\%} vs 87{\%}, p = 0.002) and multivariate (hazard ratio 1.5, 95{\%} CI 1.2 to 1.7, p < 0.0001) Cox regression analyses. ADO refusals were not correlated with improved post-transplant survival and >8 ADO refusals was associated with higher risk-adjusted post-transplant mortality (odds ratio 1.7, 95{\%} confidence interval 1.0 to 2.9, p = 0.04). CONCLUSIONS: Refusal of ADOs is associated with higher risk-adjusted mortality after listing (independent of transplantation), without improvement in post-transplant outcomes. So, although a “perfect” organ would be ideal, acceptance of one that is “good enough” has the potential to improve survival among pediatric candidates for heart transplantation.",
keywords = "donor organ refusals, heart transplant, pediatrics, post-transplant outcomes, waitlist mortality",
author = "Davies, {Ryan R} and Maria Bano and Ryan Butts and Jaquiss, {Robert Douglas Benjamin} and Richard Kirk",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.healun.2018.09.026",
language = "English (US)",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",

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TY - JOUR

T1 - Donor organ turn-downs and outcomes after listing for pediatric heart transplant

AU - Davies, Ryan R

AU - Bano, Maria

AU - Butts, Ryan

AU - Jaquiss, Robert Douglas Benjamin

AU - Kirk, Richard

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: Pediatric heart transplant waitlist mortality remains significant but allograft offer refusals are common and allografts continue to be discarded. Our aim in this study was to assess the impact of donor organ refusals on mortality after listing using a multi-institutional data set. METHODS: In this study we conducted a retrospective review of donor offers made to pediatric (<18 years) recipients in the United States in the period from 2007 to 2017. Candidates were stratified by whether they refused an acceptable donor offer (ADO). Acceptance was defined as an offer from a donor <40 years old and within 1,000 miles that was ultimately accepted by a waitlist candidate. Candidate survival after an offer was assessed. RESULTS: There were 12,447 hearts offered at least once to a pediatric candidate. Most candidates (n = 4,282, 84.4%) refused the first offer, and 677 (15.4%) of these subsequently died or were removed from the list for deterioration. Refusal of an ADO was associated with higher mortality after listing, independent of transplant, in both univariate (1 year: 92% vs 87%, p = 0.002) and multivariate (hazard ratio 1.5, 95% CI 1.2 to 1.7, p < 0.0001) Cox regression analyses. ADO refusals were not correlated with improved post-transplant survival and >8 ADO refusals was associated with higher risk-adjusted post-transplant mortality (odds ratio 1.7, 95% confidence interval 1.0 to 2.9, p = 0.04). CONCLUSIONS: Refusal of ADOs is associated with higher risk-adjusted mortality after listing (independent of transplantation), without improvement in post-transplant outcomes. So, although a “perfect” organ would be ideal, acceptance of one that is “good enough” has the potential to improve survival among pediatric candidates for heart transplantation.

AB - BACKGROUND: Pediatric heart transplant waitlist mortality remains significant but allograft offer refusals are common and allografts continue to be discarded. Our aim in this study was to assess the impact of donor organ refusals on mortality after listing using a multi-institutional data set. METHODS: In this study we conducted a retrospective review of donor offers made to pediatric (<18 years) recipients in the United States in the period from 2007 to 2017. Candidates were stratified by whether they refused an acceptable donor offer (ADO). Acceptance was defined as an offer from a donor <40 years old and within 1,000 miles that was ultimately accepted by a waitlist candidate. Candidate survival after an offer was assessed. RESULTS: There were 12,447 hearts offered at least once to a pediatric candidate. Most candidates (n = 4,282, 84.4%) refused the first offer, and 677 (15.4%) of these subsequently died or were removed from the list for deterioration. Refusal of an ADO was associated with higher mortality after listing, independent of transplant, in both univariate (1 year: 92% vs 87%, p = 0.002) and multivariate (hazard ratio 1.5, 95% CI 1.2 to 1.7, p < 0.0001) Cox regression analyses. ADO refusals were not correlated with improved post-transplant survival and >8 ADO refusals was associated with higher risk-adjusted post-transplant mortality (odds ratio 1.7, 95% confidence interval 1.0 to 2.9, p = 0.04). CONCLUSIONS: Refusal of ADOs is associated with higher risk-adjusted mortality after listing (independent of transplantation), without improvement in post-transplant outcomes. So, although a “perfect” organ would be ideal, acceptance of one that is “good enough” has the potential to improve survival among pediatric candidates for heart transplantation.

KW - donor organ refusals

KW - heart transplant

KW - pediatrics

KW - post-transplant outcomes

KW - waitlist mortality

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U2 - 10.1016/j.healun.2018.09.026

DO - 10.1016/j.healun.2018.09.026

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JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

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