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

Abstract

Background: Despite considerable progress in heart transplantation, pediatric waiting list mortality is still high, and often patients do not have enough time to wait.We hypothesized that extending the donor criteria regarding age and weight mismatch does not significantly affect the early follow-up.Methods: We retrospectively analyzed our pediatric heart transplantation patients operated on from 2014 to 2020 for high (>3.0) or low (<0.6) donor-recipient weight ratio (DRWR) or chronological age mismatches (donor organ >5 years older than recipient age). This patient cohort constituted "mismatched heart transplantations" (mHTX). We compared mHTX preoperative status, postoperative course, 1-year survival, and early clinical follow-up to standard pediatric heart transplantations (sHTX).Results: We performed 20 pediatric heart transplantations-10 mHTX and 10 sHTX.The minimum DRWR was 0.44, the maximum was 5.60, and the maximum age mismatch was 42.6 years. Median days in the intensive care unit (p = .436) and timeto-first-rejection episode (p = .925) were comparable. Nine patients in each group were alive after 1 year, two patients were operated within 1 year of follow-up. One mHTX patient developed cardiac allograft vasculopathy after 15 months and died 648 days after transplantation (p = .237). All other patients were alive at the end of follow-up and in good clinical conditions (median follow-up for mHTX was 732.5 days, 1149.5 days for sHTX). Conclusion:Postoperative course and early follow-up after mHTX were comparable to sHTX. In urgent clinical situations, extended donor criteria may be considered an additional option for pediatric heart transplantation.

Family management of child waiting for a organ transplant / Manejo familiar da criança que espera por um transplante de órgãos

“…5 O The increase in the mortality rate of children waiting for organ transplantation affects families, and the possibility of a child's death creates a sense of despair among family members. [6][7] According to official data from the Brazilian Association of Organ Transplantation (ABTO), in 2022, 286 children were added to the waiting list for transplantation, bringing the total number of children in the waiting list to 1,249; of these, 26 died while waiting for an organ in the first half of that year. 8 Studies point to the need for family assessment and intervention in the pre-transplant period.…”