The COVID‐19 pandemic has influenced organ transplantation decision making. Opinions regarding the utilization of coronavirus disease‐2019 (COVID‐19) donors are mixed. We hypothesize that COVID‐19 infection of deceased solid organ transplant donors does not affect recipient survival. All deceased solid organ transplant donors with COVID‐19 testing results from March 15, 2020 to September 30, 2021 were identified in the OPTN database. Donors were matched to recipients and stratified by the COVID‐19 test result. Outcomes were assessed between groups. COVID‐19 test results were available for 17 694 donors; 150 were positive. A total of 269 organs were transplanted from these donors, including 187 kidneys, 57 livers, 18 hearts, 5 kidney‐pancreases, and 2 lungs. The median time from COVID‐19 testing to organ recovery was 4 days for positive and 3 days for negative donors. Of these, there were 8 graft failures (3.0%) and 5 deaths (1.9%). Survival of patients receiving grafts from COVID‐19‐positive donors is equivalent to those receiving grafts from COVID‐19‐negative donors (30‐day patient survival = 99.2% COVID‐19 positive; 98.6% COVID‐19 negative). Solid organ transplantation using deceased donors with positive COVID‐19 results does not negatively affect early patient survival, though little information regarding donor COVID‐19 organ involvement is known. While transplantation is feasible, more information regarding COVID‐19‐positive donor selection is needed.
Post-transplant lymphoproliferative disorders (PTLD) are heterogenous lymphoproliferative disorders that develop as a consequence of immunosuppression in transplant recipients. We sought to determine if subtypes of PTLD correlated with different outcomes. We performed a retrospective review of PTLD occurring in pediatric heart transplant recipients. A total of 558 children and infants underwent cardiac transplantation at our institution between 1985 and 2019 and were followed until March 2021. Forty-nine of 558 patients developed PTLD (8.8%). As compared to older children (>one year of age), infant recipients (<three months of age) were less likely to develop PTLD. Monomorphic PTLDs (M-PTLD, 61%) was the most common subtype at initial diagnosis, followed by non-destructive (21%), polymorphic (14%), and classic Hodgkin lymphoma (cHL, 4%). Patients who underwent transplantation at a young age (<three months) had significantly lower rates of M-PTLD or cHL and a longer time from transplant to PTLD diagnosis as compared to children older than one year at transplant (p = 0.04). Although not reaching statistical significance, patients with a shorter time to PTLD diagnosis showed a trend toward higher rates of M-PTLD or cHL. As expected, the overall survival (OS) of patients with M-PTLD or cHL was significantly lower than patients with non-destructive or polymorphic PTLD.
Introduction: Health related quality of life in children who have undergone the Ross procedure has not been well characterized. The aim of this study was to characterize HRQOL in this cohort and compare to children with other CHD. Method: In this cross sectional, single-center study, HRQOL was assessed in patients who underwent a non-neonatal Ross procedure using the Pediatric Quality of Life Inventory (PedsQL). Ross cohort scores were compared with healthy norms, patients with CHD requiring no surgical intervention or had curative surgery (Severity 2, S2), and patients who were surgically repaired with ≥ 1 surgical procedure and with significant residual lesion or need for additional surgery (Severity 3, S3). Associations between PedsQL score and patient factors were also examined. Results: 68 patients completed surveys. Nearly 1/6 of patients had overall scores below the cut-off for at-risk status for impaired HRQOL. There was no difference in overall HRQOL score between the Ross cohort and healthy children (p=0.56) and S2 cohort (p=0.97). HRQOL was significantly higher in the Ross cohort compared to S3 cohort (p =0.02). This difference was driven by a higher psychosocial HRQOL in the Ross cohort as compared to S3 cohort (p =0.007). Anxiety scores were significantly worse in the Ross cohort compared to both S2 (p=0.001) and S3 (p=0.0017), respectively. Conclusion: Children who have undergone a Ross procedure report HRQOL equivalent to CHD not requiring therapy and superior to CHD with residual lesions. Despite these reassuring results, providers should be aware of potential anxiety among Ross patients.
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