Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Transplantation. 2023 Jul 1;107(7):1554-1563. doi: 10.1097/TP.0000000000004525. Epub 2023 Jun 20.
The availability of heart donors is limited by organ shortage. Due to concerns of reduced survival, donors with depressed left ventricular ejection fraction (LVEF <50%) have been cautiously used in pediatric heart transplantation. One strategy to expand the donor pool is to re-evaluate whether lower donor LVEF may be acceptable for transplantation.
We performed a multicenter retrospective cohort study of patients <18 y receiving heart transplants from April 2007 to September 2021 using the United Network of Organ Sharing dataset. We excluded retransplants and multiorgan transplants. Cut-point analyses of LVEF was performed and Kaplan-Meier method was used to compare 1-y survival for new cut-points and the standard (LVEF >50%).
The analytic sample consisted of 5255 patients. Recipients receiving hearts with lower LVEFs were more likely to be on ventilator and extracorporeal membrane oxygenation support. Recipients did not differ in waitlist times or transplant status. Cut-point analysis identified LVEF 45% as a potentially new cutoff. One-year survival of recipients of donors with LVEF ≥45% (92.1%; 95% confidence interval [CI], 91.3%-92.8%) was similar to that of LVEF >50% (92.1%; CI, 91.4%-92.9%). Survival for the LVEF 45%-49% (88.8%; CI, 72.9%-95.7%) cohort was slightly lower than the ≥50% cohort, albeit nonsignificant.
One-year survival among pediatric heart transplants using a donor heart LVEF threshold of 45% or 40% was similar to a threshold of 50%. However, the finding is based on a small number of patients with LVEF <50%, and future larger prospective studies are warranted to confirm the findings of this study before a lower LVEF threshold is considered.
心脏供体的可用性受到器官短缺的限制。由于担心存活率降低，射血分数（LVEF＜50%）降低的供体在儿科心脏移植中一直被谨慎使用。扩大供体库的一种策略是重新评估较低的供体 LVEF 是否可接受用于移植。
我们使用美国器官共享网络数据集对 2007 年 4 月至 2021 年 9 月期间接受心脏移植的＜18 岁患者进行了一项多中心回顾性队列研究。我们排除了再次移植和多器官移植。对 LVEF 进行了切点分析，并使用 Kaplan-Meier 方法比较了新切点和标准（LVEF＞50%）的 1 年生存率。
分析样本包括 5255 例患者。接受 LVEF 较低心脏的患者更有可能使用呼吸机和体外膜肺氧合支持。两组患者在等待时间或移植状态方面没有差异。切点分析确定 LVEF 45%为潜在新切点。LVEF≥45%（92.1%；95%置信区间[CI]，91.3%-92.8%）供体受者的 1 年生存率与 LVEF＞50%（92.1%；CI，91.4%-92.9%）相似。LVEF 45%-49%（72.9%-95.7%）队列的生存率略低于≥50%队列，但无统计学意义。
使用供体心脏 LVEF 阈值为 45%或 40%进行儿科心脏移植的 1 年生存率与阈值为 50%相似。然而，这一发现是基于少数 LVEF＜50%的患者，需要进行更大规模的前瞻性研究来证实本研究的结果，然后才能考虑较低的 LVEF 阈值。
