Division of Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
J Thorac Cardiovasc Surg. 2017 Aug;154(2):528-536.e1. doi: 10.1016/j.jtcvs.2016.12.071. Epub 2017 Mar 11.
According to Organ Procurement Transplant Network policy, hearts from donors age <18 years are offered to pediatric recipients before being offered to adults of the same health status. We aimed to analyze differences in the use of adolescent donor hearts between adult and pediatric candidates and also to analyze the outcomes of pediatric candidates in which an adolescent donor heart was refused and later used in an adult recipient.
All adolescent donors (age 12-17 years) for 2000 to 2015 were identified using the standard United Network of Organ Sharing dataset and matched against the Potential Transplant Recipient dataset.
Of the 2457 adults who received an adolescent heart, 855 (35%) received it after at least 1 refusal by a pediatric candidate (n = 844). Of the 844 pediatric candidates, 643 (76%) subsequently underwent transplantation (designated PCTs) and 201 (24%) never underwent transplantation (designated PCNTs). Among the latter group, 87 patients (43%) died or became too ill for transplantation. These 87 PCNTs refused 256 hearts that were later accepted by adult recipients. Donor quality was the most common reason for refusal. Overall, adult recipients had similar post-transplantation survival compared with PCTs, all pediatric transplants, and all adult transplants (P > .10). A breakdown of adolescent heart donors by year shows a trend toward increased use in pediatric candidates.
A significant number of adolescent donor hearts that are refused by pediatric centers result in excellent post-transplantation outcomes in adult recipients. One in 10 pediatric candidates died on the waitlist after refusal of these hearts used by adult recipients. This warrants careful evaluation of the refusal criteria used by pediatric centers. Encouragingly, there now appears to be a trend toward an increased use of adolescent donor hearts by pediatric centers.
根据器官获取与移植网络的政策，年龄<18 岁的供体心脏在提供给相同健康状况的成人之前，先提供给儿科受者。我们旨在分析青少年供体心脏在成人和儿科受者之间的使用差异，同时分析拒绝用于儿科受者但后来用于成人受者的青少年供体心脏的结果。
使用标准的美国器官共享网络数据集识别 2000 年至 2015 年期间所有的青少年供体（年龄 12-17 岁），并与潜在移植受者数据集进行匹配。
在 2457 名接受青少年心脏的成年人中，有 855 名（35%）在至少被一名儿科受者拒绝后接受了心脏（n=844）。在 844 名儿科受者中，643 名（76%）随后接受了移植（指定为 PCTs），201 名（24%）从未接受过移植（指定为 PCNTs）。在后一组中，有 87 名患者（43%）死亡或因病情太重而无法接受移植。这 87 名 PCNTs 拒绝了 256 颗随后被成年受者接受的心脏。拒绝的主要原因是供体质量。总体而言，成年受者的移植后存活率与 PCTs、所有儿科移植和所有成人移植相似（P>.10）。按年份细分的青少年供体心脏显示出在儿科受者中使用增加的趋势。
大量被儿科中心拒绝的青少年供体心脏在成年受者中产生了极好的移植后结果。在这些被成年受者使用的心脏拒绝后，有 1/10 的儿科受者在等待名单上死亡。这需要仔细评估儿科中心使用的拒绝标准。令人鼓舞的是，现在儿科中心似乎有增加使用青少年供体心脏的趋势。
