{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T17:36:18Z","timestamp":1784396178075,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,11,27]],"date-time":"2020-11-27T00:00:00Z","timestamp":1606435200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Donor utilization rates continue to be low for pHT, however, efforts to expand the donor acceptance criteria have shown mixed results in single\u2010institution studies in pediatric and adult transplantation. Purpose of this study is to assess impact of individual and cumulative donor risk factors on transplant outcomes as well as the interplay between donor and recipient risk factors as it relates to transplant outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We analyzed pHT UNOS data (2008\u20102018) to compare the recipient characteristics, donor characteristics, and outcomes based on donor ejection fraction of less than 50% (low EF) and or ischemic time of greater than 4\u00a0hours (prolonged IT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 4345 pHT were performed of which 1309 (30.1%) were with prolonged IT and 122 (2.8%) in low EF. Additionally, 58 (1.3%) were performed with both low EF and prolonged IT (combined risk). Rest (2856 patients, 65.7%) was considered low risk. Recipients of combined risk were more likely to be younger, have post\u2010surgical congenital heart disease, be on ECMO or ventilator but less likely on VAD (all <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01) compared with any other group. Waitlist time was significantly lower for low EF (mean 39\u00a0days, 15\u2010109) or combined risk group (36\u00a0days, range 15\u201080) compared with other groups (60\u00a0days, range 23\u2010125) (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.01). 1\u2010year mortality was 8% in low\u2010risk group, 12% in prolonged IT, 14% in reduced EF, and 28% in combined risk patients (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01). Number of treated rejections in one year were significantly higher in prolonged IT and combined risk group compared to other groups (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01). When stratified by recipient risk, there was no difference in outcomes for low risk, prolonged IT, or low EF groups; however, there were significant survival differences for high\u2010risk recipient versus low\u2010risk recipient in each donor group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Lower EF donors performed similar to prolonged IT donor, but were uncommonly used. Acceptance of risk was common in recipients deemed higher risk for waitlist mortality and led to shorter wait times. Caution should be used in accepting combined risk transplants. The recipient risk factors have significant impact on outcomes across all donor risk groups and further analysis will help balance the waitlist mortality with post\u2010transplant outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.13912","type":"journal-article","created":{"date-parts":[[2020,11,27]],"date-time":"2020-11-27T20:16:36Z","timestamp":1606508196000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Interplay between donor and recipient factors impacts outcomes after pediatric heart transplantation: An analysis from the united network for organ sharing database"],"prefix":"10.1111","volume":"25","author":[{"given":"Bibhuti","family":"Das","sequence":"first","affiliation":[{"name":"Pediatric Cardiology Texas Children\u2019s Hospital  Austin TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaimin R.","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Cardiovascular and Thoracic Surgery University of Louisville  Louisville KY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranava","family":"Sinha","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Children\u2019s National Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Children\u2019s National Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahaaldin","family":"Alsoufi","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery University of Louisville School of Medicine Norton Children's Hospital  Louisville KY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8358-9783","authenticated-orcid":false,"given":"Shriprasad R.","family":"Deshpande","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Children\u2019s National Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2020.01.1345"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12149"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13676"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2017.07.018"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2003.10.017"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3182192a84"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2011.05.001"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.000029"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2013.11.006"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2018.09.026"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03932.x"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.009120"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2017.03.002"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2009.06.013"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.815712"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.09.074"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14252"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13671"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13589"}],"container-title":["Pediatric 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