{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T04:05:17Z","timestamp":1745899517695,"version":"3.40.4"},"reference-count":18,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi250283-4\"><jats:title>Importance<\/jats:title><jats:p>Older children awaiting a heart transplant (HT) sometimes receive a heart offer from a donor with a history of drug use (HDU). The effect of using such donor hearts on posttransplant survival in pediatric recipients is unclear.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250283-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the association of using hearts from donors with HDU on posttransplant graft survival in pediatric HT recipients.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250283-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>For this retrospective cohort study, all pediatric HT recipients (aged &amp;amp;lt;18 years) in the Organ Procurement and Transplantation Network database during January 1, 2000, to December 31, 2020, were identified. Among the recipients who received a heart from a donor with HDU, nearly all donors were aged 11 years or older. A propensity score (PS) model was developed to assess the probability of receiving a heart from a donor with HDU using baseline recipient and donor variables, limiting the study cohort to donors aged 11 years or older. Data were analyzed from October 2023 to November 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250283-7\"><jats:title>Exposure<\/jats:title><jats:p>HT using a heart from a donor with HDU (exposure group) vs from a donor without HDU (control group).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250283-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The main outcome was graft loss (death or retransplant) assessed at 90 days after transplant and long term among 90-day survivors. Kaplan-Meier survival curves and a Cox proportional hazards regression model that accounted for matching of exposure and control groups were used to compare risk of graft loss.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250283-9\"><jats:title>Results<\/jats:title><jats:p>This study included 2730 pediatric HT recipients. Their median age at HT was 14 years (IQR, 11-16 years), and most (1642 [60.1%]) were male. Overall, the exposure group comprised 822 children who received a heart from a donor with HDU; of these, 765 (93.1%) were PS matched to the control group. There was no difference in risk of graft loss within 90 days (hazard ratio [HR], 0.93 [95% CI, 0.55-1.57]; <jats:italic>P<\/jats:italic>\u2009=\u2009.78) or at long-term follow-up (HR, 1.04 [95% CI, 0.87-1.25]; <jats:italic>P<\/jats:italic>\u2009=\u2009.68) between PS-matched groups. Risk of graft loss within 90 days was not significantly different in children who received a heart from a donor with a history of cocaine use (157 pairs) vs children in the control group (HR, 0.55 [95% CI, 0.19-1.54]; <jats:italic>P<\/jats:italic>\u2009=\u2009.25); however, the risk of long-term graft loss among 90-day survivors was significantly higher (HR, 2.03 [95% CI, 1.35-3.06]; <jats:italic>P<\/jats:italic>\u2009=\u2009.001).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250283-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this cohort study of pediatric HT recipients, there was no association of 90-day graft survival with donor HDU; however, donor history of cocaine use was associated with a higher risk of long-term graft loss. These findings may be important when considering a donor with HDU for pediatric HT candidates.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.7766","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T15:32:06Z","timestamp":1745854326000},"page":"e257766","source":"Crossref","is-referenced-by-count":0,"title":["Donor History of Drug Use and Graft Survival in Pediatric Heart Transplant Recipients"],"prefix":"10.1001","volume":"8","author":[{"given":"Paul","family":"Esteso","sequence":"first","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberlee","family":"Gauvreau","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Milligan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Vo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Fynn-Thompson","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth D.","family":"Blume","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tajinder P.","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"issue":"2S1","key":"zoi250283r1","doi-asserted-by":"publisher","first-page":"S305","DOI":"10.1016\/j.ajt.2024.01.016","article-title":"OPTN\/SRTR 2022 annual data report: heart.","volume":"24","author":"Colvin","year":"2024","journal-title":"Am J Transplant"},{"issue":"20","key":"zoi250283r2","doi-asserted-by":"publisher","first-page":"1943","DOI":"10.1056\/NEJMc1802706","article-title":"The drug-intoxication epidemic and solid-organ 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