title: Pediatric heart transplantation from donors with depressed ventricular function: an analysis of the United Network of Organ Sharing Database.
abstract: BACKGROUND
  Wait-list mortality for children awaiting heart transplantation remains high. Potential donor hearts with depressed ventricular function are often declined. We aimed to test the hypothesis that pediatric heart transplant recipients of grafts with depressed ventricular function would have comparable survival with those with normal function.
  
  
  RESULTS
  A retrospective study was performed for pediatric heart transplants from the United Network of Organ Sharing Database from October 26, 1999, to June 30, 2011. Patients were grouped based on accepted donor left ventricular ejection fraction (LVEF): normal function (LVEF ≥55%), mildly depressed function (LVEF 45%-54%), or moderately-to-severely depressed function (LVEF <45%). During the study period, there were 3672 pediatric heart transplants; 3306 (90%) had a LVEF reported. Ventricular function was mildly depressed in 245 (7%) and moderately-to-severely depressed in 172 (5%). Patients receiving grafts with moderately-to-severely depressed function were more likely to be younger and weigh less (P<0.001 for both) than those receiving grafts with normal function. Median graft survival from accepted donors with normal ventricular function (10.6 years) was similar to survival from accepted donors with mildly depressed ventricular function (9.7 years; P=0.24) and from accepted donors with moderately-to-severely depressed ventricular function (9.1 years; P=0.13). On propensity-matched analysis, donor ventricular function was not associated with graft survival.
  
  
  CONCLUSIONS
  The use of donors with depressed ventricular function is uncommon in pediatric heart transplantation (<15% of all transplants), yet graft survival does not differ significantly from accepted donors with normal ventricular function. Hearts from donors with depressed ventricular function may be considered in selected patients.
authors.affiliation: Department of Pediatrics and Department of Surgery, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
authors.forename: Kimberly Y
authors.initials: KY
authors.lastname: Lin
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Paridon
authors.forename: Xuemei
authors.initials: X
authors.lastname: Zhang
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Beth D
authors.initials: BD
authors.lastname: Kaufman
authors.forename: Robert E
authors.initials: RE
authors.lastname: Shaddy
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D016027:Heart Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D014019:Tissue Donors; D014481:United States / Q000453:epidemiology; D018754:Ventricular Dysfunction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D014850:Waiting Lists / Q000401:mortality*
keywords: pediatrics; survival; transplantation