A new study provides hope that the number of children dying on the transplantation list while waiting for a new heart could potentially be reduced dramatically.
The study, published online in the Annals of Thoracic Surgery , demonstrates that many of the donor hearts deemed "high-risk" can be transplanted with the same survival rates as "low-risk" donor hearts.
One in five children die awaiting a suitable donor heart, and some of these potential recipients missed their opportunity because they were offered donor hearts that transplant programs refused because they were thought to be of poor quality." David Morales, MD, director of congenital heart surgery and Clark-Helmsworth Chair of cardiovascular surgery at Cincinnati Children's Hospital Medical Center
Dr. Morales is senior author of the study.
"However, these hearts were often transplanted into other donors with good results, and some of those potential recipients never got the opportunity to be transplanted. Our study demonstrates that traditionally perceived high-risk donors may have been associated with worst post-transplant survival because of the recipients they were transplanted into and not because of the donor hearts. While it's important to carefully consider potential donor hearts for transplantation, transplant programs should consider accepting hearts from certain donors traditionally considered poor quality."
For the study, the Cincinnati Children's researchers reviewed the United Network for Organ Sharing (UNOS) database for thoracic organ transplants between Jan. 2006 and Dec. 2015 in children up to 18 years old. They identified "high-risk" transplant donors as those above a certain age, those who needed cardiopulmonary resuscitation and those who died due to stroke. They matched low- and high-risk donors on characteristics of the recipient and then analyzed one-year survival outcomes.
The study found that transplant recipients considered "high-risk" by utilization and survival-based criteria led to similar survival as transplant recipients from "low-risk" donors.
"Currently, there is not a universal system by which transplant institutions list patients for transplant," says Dr. Morales. "In other words, hospitals accept organs and list patients for transplant under different criteria, often based not on the latest clinical data nor nationally accepted clinical standards but on a program's or provider's past experiences.
"A risk-based matching system that couples the optimal donor for a given transplant recipient to result in the best predicted outcome for each transplant, and achieving the highest survival years post-transplant for the entire community, are what we are striving for," he says. "Getting to transplantation is NOT the goal. Having the most children healthy and alive post-transplantation for the most years is the goal." Related Stories
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