Hearts from adolescent donors are underutilized, could reduce CAV risk

New research suggests greater use of early adolescent (EA) heart donors could save lives and reduce the gap between organ need and availability.

According to a new study, hearts from donors age 10-14 can be safely transplanted to adults and are also associated with a reduced risk of cardiac allograft vasculopathy (CAV).

Using the United Network for Organ Sharing (UNOS) database, the study identified 1,123 adults who received hearts from EA donors over a 21-year span. With propensity scoring, 944 recipients of EA donor hearts were matched to 944 recipients of transplants from donors in the “usual age group”—18 to 55.

Lead researcher Shivank Madan, MD, of the division of cardiology at Albert Einstein College of Medicine in New York, and colleagues published their results in JACC: Heart Failure.

They found no difference in recipient survival or primary graft failure (PGF) rates between the two groups at 30 days, one year, three years or five years post-transplant. Further, adult patients who received a heart from a young donor showed a 20 percent decreased risk of CAV.

The authors pointed out more than 20,000 patients in the United States may benefit from heart transplantation, but only about 2,000 to 2,400 transplants are performed in the country each year.

There has been a hesitation to use EA donor hearts in adult patients, the authors noted, “due to theoretical concerns for lack of hormonal activation and changes in left ventricular mass.”

“Despite a shortage of donor organs, the donor acceptance rates continue to remain low,” Madan and colleagues wrote. “There is a need to safely increase the utilization rates of already available donor organs using evidence based criteria, so that heart transplantation can be made available to a greater number of patients.”

The study analyzed only EA donor hearts that had been rejected for pediatric candidates. Nearly half of the adult recipients of EA hearts in the study were females, which was expected given they are generally better size matches to the younger donors.

In an accompanying editorial, Maria Rosa Costanzo, MD, of the Advocate Heart Institute in Naperville, Illinois, pointed out EA hearts are being underutilized for pediatric patients as well. She referenced another analysis from the UNOS database showing that 256 EA hearts were denied to pediatric candidates from 2000 to 2015. Eighty-seven of the children either died or became too sick for a transplant, but the EA hearts were later accepted by adults.

“The rejection of young donor hearts is an inexcusable disservice both to adult HT candidates, as demonstrated by Madan and Colleagues, and to children with end-stage heart disease awaiting HT,” Costanzo wrote.

Madan and colleagues mentioned one limitation of their study was not having a way to analyze whether hearts from early adolescent donors changed in size post-transplant. Also, UNOS doesn’t have information on all CAV cases, as those data are gathered via self-reporting by transplant centers.

Still, the authors believe their findings should clear the way for more EA donor hearts to be used in transplants.

“Our study provides important post-transplant outcomes data and shows that appropriately selected adults who receive donor hearts from young adolescents (10 to 14 years) have good short term and intermediate term survival,” they wrote. “These results should help adult transplant programs in making informed decisions about accepting or rejecting EA donor heart offers for adult patients.”