Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Family Medicine, University of Oklahoma, Tulsa, Oklahoma, USA.
J Heart Lung Transplant. 2017 May;36(5):554-558. doi: 10.1016/j.healun.2016.11.009. Epub 2016 Dec 1.
Donors are matched for weight in pediatric heart transplantation (PHT), yet age differences are not considered in this decision. In this study we attempt to identify the effect of age differences in weight-matched patients and the effect these differences have on post-transplant survival.
The United Network of Organ Sharing (UNOS) database was queried for the period from October 1987 to March 2014 for all pediatric heart transplant patients. Transplants with donor-to-recipient (D-R) weight ratios of 0.8 to 1.5 were identified (weight-matched). D-R age differences were categorized as: donors 5 years younger than recipients (D<R-5); donors within 5 years of recipients (D=R±5); and donors 5 years older than recipients (D>R+5).
A total of 4,408 patients were identified as weight-matched transplants. Of these transplants, 681 were D>R+5, 3,596 were D=R±5 and 131 were D<R-5. D>R+5 transplants were found to be associated with decreased post-transplant survival compared with D=R±5 (p = 0.002). Rates of acute rejection were similar among all groups but post-transplant coronary allograft vasculopathy (CAV) was more prevalent in D>R+5 than D=R±5 patients (28% and 18%, respectively; p < 0.001). Increasing age difference by each year was associated with decreasing median post-transplant survival time (p < 0.001; hazard ratio 1.018, range 1.011 to 1.025). The overall negative association with mortality was due to the adolescent cohort (11 to 17 years), specifically D>R+5 transplants, utilizing organs from donors >25 of age.
In PHT, increasing D-R age difference decreases survival; however, this effect is driven by recipients 11 to 17 years old and donors >25 years old. Allocation of younger donor organs to adolescent recipients should be a priority.
在儿科心脏移植（PHT）中，供体是按照体重匹配的，但在这个决策中没有考虑年龄差异。在这项研究中，我们试图确定体重匹配的患者中年龄差异的影响，以及这些差异对移植后生存的影响。
从 1987 年 10 月至 2014 年 3 月，我们使用美国器官共享网络（UNOS）数据库查询所有儿科心脏移植患者。确定供受者体重比为 0.8 至 1.5 的移植（体重匹配）。将供受者年龄差异分为：供者比受者年轻 5 岁（D<R-5）；供者与受者年龄相差 5 岁以内（D=R±5）；以及供者比受者年长 5 岁以上（D>R+5）。
共确定 4408 例体重匹配的移植。其中，681 例为 D>R+5，3596 例为 D=R±5，131 例为 D<R-5。与 D=R±5 相比，D>R+5 移植的移植后生存率降低（p=0.002）。各组急性排斥反应发生率相似，但 D>R+5 患者的移植后冠状动脉移植血管病（CAV）更为常见（分别为 28%和 18%；p<0.001）。每年年龄差异的增加与移植后中位生存时间的缩短相关（p<0.001；风险比 1.018，范围 1.011 至 1.025）。与死亡率的整体负相关是由于青少年队列（11 至 17 岁），特别是 D>R+5 移植，使用了>25 岁的供体器官。
在 PHT 中，供受者年龄差异的增加会降低生存率；然而，这种影响是由 11 至 17 岁的受者和>25 岁的供者引起的。应优先分配年轻供体器官给青少年受者。
