Transplantation of “high-risk” donor hearts: Implications for infection

Gaffey, Ann C.; Doll, Stacey L.; Thomasson, Arwin; Venkataraman, Chantel M.; Chen, Carol W.; Goldberg, Lee R.; Blumberg, Emily A.; Acker, Michael A.; Stone, Francis; Atluri, Pavan

doi:10.1016/j.jtcvs.2015.12.062

Cited by 39 publications

(32 citation statements)

References 22 publications

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“…These findings are similar to the adult study evaluating outcomes of blood culture positive donors in kidney, liver, and heart transplantation . Selective use of PHS “increased risk” donors has been shown in other analysis to result in similar post‐transplant survival . Donors at high risk of positive blood culture or those with known positive blood culture likely comprise some of this “increased risk” pool for which post‐transplant survival is not impacted and therefore if all else with the donor seems suitable for transplant (considering the candidate's risk profile) then donor should not be declined solely on the basis of positive blood culture or likely positive blood culture.…”

Section: Discussionsupporting

confidence: 73%

“…20 Selective use of PHS "increased risk" donors has been shown in other analysis to result in similar post-transplant survival. 10 Donors at high risk of positive blood culture or those with known positive blood culture likely comprise some of this "increased risk" pool for which post-transplant survival is not impacted and therefore if all else with [43][44][45][46] The use of BCPD, along with active surveillance and judicious use of antibiotics in such recipients, will allow an expansion of the donor pool for pediatric heart transplant recipients without increasing morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…One of the many ways to increase the availability of organs is using high‐risk donors or suboptimal organs. Pediatric studies using high‐risk donors, donors previously refused and donors with depressed ventricular function have been successful …”

Section: Introductionmentioning

confidence: 99%

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

Aggarwal

2018

Clinical Transplantation

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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.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

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

Aggarwal

2018

Clinical Transplantation

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“…Their findings were supported by that of Patel et al who found no negative impact on recipient survival after transplant with an HCV donor heart provided they had pre‐screening. On the contrary, Xu et al’s findings described an increased risk of transmission of hepatitis C positivity as well as hepatitis B positivity between the IRD and recipient. We report similar findings as described in the study by Xu et al where HCV seropositivity was significantly associated with worse survival.…”

Section: Discussionmentioning

confidence: 85%

“…Previous studies have shown no difference in survival and post-operative outcomes between patients who received IRD grafts or SRD grafts. [1][2][3][4][5][6] There are scant data in literature assessing the impact of individual risk factors of these IRDs on recipient outcomes. The present study aims to investigate the association between the social behaviors of IRD and recipient outcomes after heart transplantation.…”

Section: Introductionmentioning

confidence: 99%

Association between increased‐risk donor social behaviors and recipient outcomes after heart transplantation

Okoh

Chan

Schultheis

et al. 2020

Clinical Transplantation

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Background This study aims to investigate the association between social behaviors of increased‐risk donors (IRD) and recipient outcomes after heart transplantation. Methods The United Network for Organ Sharing (UNOS) database was queried to identify patients who received a heart transplant between 2004 and 2015. Patients were grouped based on donor's risk status (IRD vs standard risk donor [SRD]). Recipients of IRD were categorized based on donor social behaviors (SB), and recipient survival was assessed. Cox regression analysis was used to identify associations between SB of donors and recipient survival. Results Out of 22 333 heart transplantations performed during the study period, 2769 (12%) received an IRD graft with the following SB: Unprofessional tattoos or piercings (n = 1722) (63%), cocaine use (n = 916) (33%), heavy smoking (n = 437) (16%), and heavy alcohol abuse (n = 610) (22%). Viral screens detected 72(3%) hepatitis B virus (HBV) positive and 12 (0.4%) hepatitis C virus (HCV) positive at donation. There was no difference in recipient survival based on both donor risk and their social behaviors. Cox regression analysis found only donor HCV infection and non‐identical ABO mismatch to be associated with poor recipient survival among recipients of IR grafts. Conclusion Cardiac allografts from IRD, serologically negative for viruses, can safely be used. There is no association between social behaviors of IRD and recipient survival.

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Should Decision Making Be Shared in High-Risk Pediatric Heart Donation?

Lelkes

Patel

Joong

et al. 2020

AMA Journal of Ethics

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This article considers complexities of shared decision making in pediatric heart transplantation and suggests that decisions about pediatric heart transplantation should be shared between a clinical team and parents. This article also considers goals of shared decision making involving Public Health Service increased-risk donors and recommends policy changes to strengthen decision sharing.Need for Pediatric Donor Hearts Heart transplantation (HTx) is the standard of care for children with end-stage heart failure, with approximately 500 pediatric heart transplants performed annually in the United States. 1 A significant shortage of available organs exists, however, leading to long wait list times and significant morbidity. According to the Organ Procurement and Transplantation Network (OPTN), the average waiting time on the list for a pediatric patient from 2007 to 2014 was 115 days, with children ages 1 to 5 years waiting an average of 139 days (OPTN database). Indeed, of the 4392 children listed for HTx during this time frame, 457 (10.4%) died prior to HTx and still others were removed from the waiting list because they became "too sick to transplant."

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Transplantation of “high-risk” donor hearts: Implications for infection

Cited by 39 publications

References 22 publications

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

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

Association between increased‐risk donor social behaviors and recipient outcomes after heart transplantation

Should Decision Making Be Shared in High-Risk Pediatric Heart Donation?

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