Outcome of pediatric heart transplantation in blood culture positive donors in the United States

Abstract

Active donor infection at the time of organ procurement poses a potential infection risk and may increase post-transplant morbidity and mortality in recipients. Our hypothesis was that pediatric heart transplant recipients from blood culture positive donors (BCPD) would have increased morbidity and mortality compared to non-blood culture positive donors (NBCPD). A retrospective analysis of pediatric heart transplant recipients using the organ procurement and transplant network (OPTN) between 1987 and 2015 was conducted. Recipient as well as donor data were analyzed. Propensity score matching with 1:2 ratios was performed for recipient variables. Post-transplant morbidity and mortality were compared for recipients of BCPD and NBCPD. Among 9618 heart transplant recipients, 450 (4.7%) were from culture positive donors. Recipients of BCPD had longer duration of listing as Status 1; diagnosis of congenital heart disease or restrictive cardiomyopathy and required support (IV inotropes, Inhaled NO and LVAD) prior to transplant. Post-transplant survival between the 2 groups was not different. Propensity-matched recipients had similar length of stay; stroke rate; need for dialysis; pacemaker implantation and treated rejection episodes in the first year post-transplant. Careful acceptance of BCPD may have the potential to increase availability of donor hearts in the pediatric population.

Positive donor blood cultures are not associated with worse heart transplant survival

“…The number of candidates being added to the transplant waitlist has steadily increased over the past two decades and exceeds the number of hearts implanted each year by nearly two‐fold. Our results, in addition to previous studies, support the finding of consistently acceptable outcomes among BCPD recipients, and confirm that increased utilization of BCPD donors serves as a promising answer to the national shortage of donor hearts 12,13 …”

“…Amdani et al. thereafter conducted a study investigating the impact of BCPD on pediatric heart transplant outcomes 12 . Relying on national data obtained by UNOS from 1987 to 2015, a matched cohort comparison of BCPD ( n = 450) and non‐BCPD ( n = 9168) showed equivalent 1‐month (94.1% vs. 95.1%, p = .51) and 6‐month (88.9% vs. 89.9%, p = .63) survival.…”

“…Amdani et al. note that BCPD hearts now make up nearly 10% of transplanted pediatric hearts compared to 2% prior to 2000 12,21 . Moreover, pediatric studies using the high risk donors have been unilaterally successful 22–24 .…”

“…3 Forest et al have previously investigated the outcomes of BCPD and non-BPCPD hearts from the UNOS database from 1995 to 2009. 12 Their study included 26 813 patients, of whom 995 were BCPD and demonstrated that BCPD was associated with comparable survival at 1-year (86% vs. 87%, p = .2585) and 15-years (34% vs. 36%, p = .0929).…”

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

“…In pediatrics, only three proven or probable donor‐derived disease transmissions related to bacterial infections (all Staphylococcus species ) were reported in over 5000 pediatric donors in the United States, and there were no deaths attributed to these transmissions . More specifically, Amdani et al reported on pediatric heart transplant recipients from blood culture‐positive donors showing there was no difference in survival or post‐transplant complications with these donors compared to donors with negative blood cultures. However, with the emergence of multi‐drug‐resistant (MDR) organisms, transmission from donor to recipient of these difficult‐to‐treat organisms has been reported in adult heart transplantation, although organs from donors with some MDR organisms including carbapenamase‐resistant Klebsiella pneumoniae have been safely used in at least one adult heart transplant recipient with targeted peri‐operative and post‐operative antimicrobial administration .…”