부산대학교 도서관

Introduction: The relationship between donor age and adolescent heart transplant outcomes remains incompletely understood. We aimed to explore the effect of donor‐recipient age difference on survival after adolescent heart transplantation. Methods: The United Network for Organ Sharing database was used to identify 2,855 adolescents aged 10–17 years undergoing isolated primary heart transplantation from 1/1/2000 to 12/31/2022. The primary outcome was 10‐year post‐transplant survival. Multivariable Cox regression identified predictors of mortality after adjusting for donor and recipient characteristics. A restricted cubic spline assessed the non‐linear association between donor‐recipient age‐difference and the adjusted relative mortality hazard. Results: The median donor‐recipient age‐difference was +3 (range ‐13 to +47) years, and 17.7% (n = 504) of recipients had an age‐ difference > 10 years. Recipients with an age‐difference > 10 years had a less favorable pre‐transplant profile, including a higher incidence of priority status 1A (81.6%, n = 411 vs. 73.6%, n = 1730; p =.01). The 10‐year survival rate was 54.6% (95% confidence interval (CI) 48.8– 60.4) among recipients with a donor‐recipient age‐difference > 10 years and 66.9% (95% CI: 64.4–69.4) among those with an age‐difference ≤10 years. An age‐difference > 10 years was an independent predictor of mortality (hazard ratio 1.43, 95% CI: 1.18–1.72, p <.001). Spline analysis demonstrated that the adjusted mortality hazard increased with increasingly positive donor‐recipient age‐difference and became significantly higher at an age‐difference of 11 years. Conclusion: A donor‐recipient age‐difference > 11 years is independently associated with higher long‐term mortality after adolescent heart transplantation. This finding may help inform acceptable donor selection practice for adolescent heart transplant candidates. [ABSTRACT FROM AUTHOR]