Review of the impact of donor characteristics on pediatric heart transplant outcomes

Abstract

Heart transplantation (HTx) is a treatment option for end‐stage heart failure in children. HTx is limited by the availability and acceptability of donor hearts. Refusal of donor hearts has been reported to be common with reasons for refusal including preexisting donor characteristics. This review will focus on the impact of donor characteristics and comorbidities on outcomes following pediatric HTx. A literature review was performed to identify articles on donor characteristics and comorbidities and pediatric HTx outcomes. There are many donor characteristics to consider when accepting a donor heart. Weight‐based matching is the most common form of matching in pediatric HTx with a donor‐recipient weight ratio between 0.7 and 3 having limited impact on outcomes. From an age perspective, donors <50 years can be carefully considered, but the impact of ischemic time needs to be understood. To increase the donor pool, with minimal impact on outcomes, ABO‐incompatible donors should be considered in patients that are eligible. Other factors to be considered when accepting an organ is donor comorbidities. Little is known about donor comorbidities in pediatric HTx, with most of the data available focusing on infections. Being aware of the potential infections in the donor, understanding the testing available and risks of transmission, and treatment options for the recipient is essential. There are a number of donor characteristics that potentially impact outcomes following pediatric HTx, but these need to be taken into consideration along with their interactions with recipient factors when interpreting the outcomes following HTx.

Pediatric urgent heart transplantation with age or weight mismatched donors: Reducing waiting time by enlarging donor criteria

“…6,15 In 2020, Conway and colleagues' meta-analysis of the characteristics of the ideal donor in pediatric heart transplantation, they found that the DRWR should be between 0.7 and 3 and that donor age should be <50 years old. 5 That same year, the ISHLT published a consensus statement describing donor organ acceptability criteria for pediatric heart transplantation. The ISLHT proposed to aim for a DRWR between 0.6 and 3.0 and, especially in adolescents, the organ should not come from a donor >5 years older, especially if the donor is >25 years of age.…”

“…There is no common agreement on the influence of weight mismatch, donor age, ABO compatibility, donor comorbidities, or infections on heart transplant outcomes in children. [5][6][7][8][9] Recently, the International Society of Heart and Lung Transplantation (ISHLT) published a consensus statement summarizing the scientific evidence on pediatric heart transplantation donor organ acceptability. 10 In our study, we focused on the ISHLT consensus statement recommendations that suggest donor organs should be less than 5 years older than the recipient and donor-recipient weight ratio (DRWR) should range between 0.6 and 3.0.…”

“…To enlarge the donor pool, the impact of donor characteristics on pediatric heart transplant outcomes has been extensively debated. There is no common agreement on the influence of weight mismatch, donor age, ABO compatibility, donor comorbidities, or infections on heart transplant outcomes in children 5–9 . Recently, the International Society of Heart and Lung Transplantation (ISHLT) published a consensus statement summarizing the scientific evidence on pediatric heart transplantation donor organ acceptability 10 …”

A comprehensive strategy in donor acceptance: Impact on pediatric waitlist and heart transplant outcomes

“…The lack of established standards or guidelines for pediatric heart assessment and subsequent acceptance may limit donor utilization with direct impact on waitlist outcomes. To address some of these issues, our center's experience prompted the development of the ISHLT pediatric consensus guidelines and the suite of papers recently published in Pediatric Transplantation 9‐17 …”

A coordinated approach to improving pediatric heart transplant waitlist outcomes: A summary of the ACTION November 2019 waitlist outcomes committee meeting

“…Among those who do survive to transplant, waitlist characteristics, including waitlist duration, available mechanical support options, and renal injury all contribute to post‐transplant outcomes 3‐8 . The waitlist phase of care has received considerable attention recently, including the recent publication of an International Society for Heart & Lung Transplantation (ISHLT) consensus statement on donor organ acceptability and other important papers 9‐19 …”