Pediatric Candidates Research Articles

Bony Cochlear Nerve Canal as a Predictor for Cochlear Nerve Status in Prelingually Deaf Children.

Objectives: The presence of a functional cochlear nerve is a key issue in the preoperative evaluation of pediatric candidates for cochlear implants. Correlations between cochlear nerve deficiency (CND) and bony abnormalities of the labyrinth or bony canal of the cochlear nerve are not yet well understood. The aim of this study was to determine whether the width of the bony cochlear canal (BCNC) can serve as a reliable predictive factor for the existence of a CND. Materials and methods: A total of 11 children with a confirmed diagnosis of prelingual, severe sensorineural hearing loss were included in this study. In all patients, indication for CI was confirmed and according to the preoperative protocol, high-resolution CT and MR were performed. Reconstructions at a distance of 0.6 mm of the axial plane and images from the HRCT of temporal bones were used for measuring the width of the BCNC. The cochlear nerves were evaluated on axial and sagittal - oblique T2 - MRI images and classified as normal, hypoplastic or aplastic. Two factors were reviewed retrospectively: the presence of inner ear anomalies and the relationship between BCNC stenosis and the existence of CND. Results: From a total of 22 temporal bones analyzed (22 ears in 11 patients), inner ear malformations were detected in 6 ears from 3 patients (27.27%). All three children had a bilateral malformation, in one it was Michel deformity and in two it was IP2 (incomplete partition 2). The BCNC diameter ranged from 0.1mm to 2.33mm with a mean value of 1.46±0.6mm. CND was recorded in 4 of 22 ears and all were associated with stenosis of the BCNC. In a total of three ears with a stenotic canal, we obtained a normal finding for the cochlear nerve on MR. Conclusion: Children with BCNC stenosis have a high incidence of CND. A narrowed BCNC on CT can be an indicator for the selection of children with sensorineural hearing loss who will need to be additionally referred for MRI in order to definitively assess the status of the cochlear nerve.

In Reply: Middle Meningeal Artery Embolization for Primary Treatment of a Chronic Subdural Hematoma in a Pediatric Patient: A Systematic Review of the Literature and Case Report.

To the Editor: We thank Lu et al1 for their interest in our article. Middle meningeal artery (MMA) embolization is becoming increasingly used in a subset of pediatric patients, and in the short time since the submission of our manuscript, an additional 2 case reports have been published.2,3 In their letter, Lu et al1 described several important considerations that will guide the selection of appropriate pediatric candidates for MMA embolization. Age—We agree that the age of the patient is an important factor. Among pediatric patients, chronic subdural hematomas are most commonly associated with abusive head trauma, anticoagulation/antiplatelet treatment for congenital cardiac disease, and ventricular shunt overdrainage.4 As a result, pediatric chronic subdural hematomas are often identified in infants and young children. Less common etiologies include neoplastic disease and arachnoid cysts, which can affect pediatric patients of any age. Pediatric patients at the younger end of the spectrum present several unique challenges because of the small caliber of their blood vessels, as well as the importance of limiting iodinated contrast and ionizing radiation.5 Despite these challenges, MMA embolization in young patients is feasible and can be a safe option in select patients when performed by experienced providers. Five of the 8 cases that have been described in the literature involved patients who were 2 years of age or younger.2,3,6-8 Etiology—As highlighted by Lu et al,1 2 patients in our systematic review underwent MMA embolization in the setting of a ruptured arachnoid cyst.9,10 We fully agree that subdural hygromas associated with arachnoid cysts can be treated nonsurgically11 and that even a certain subset of subdural hematomas can also be observed in this setting. As such, we agree that MMA embolization may not be the optimal first-line treatment in such cases. Indeed, both patients described in the literature only underwent MMA embolization after first undergoing either burr hole drainage or subdural-to-peritoneal shunt placement, with subsequent symptomatic recurrence of the hematoma.9,10 Timing—As alluded to above, the timing of intervention is controversial. Only 2 of the patients described in the literature underwent MMA embolization as a first-line treatment.7,12 Given the small number of cases that have been reported to date, we agree that MMA embolization is far from becoming the standard of care among pediatric patients with chronic subdural hematomas. Nevertheless, it represents yet another treatment option in the neurosurgeon's armamentarium and warrants additional study to determine its optimal role. We thank Lu et al1 for pointing out these important considerations and look forward to seeing the pediatric neurosurgical community continue to study the indications, efficacy, and risks of pediatric MMA embolization.

Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States.

To assess the impact of technical variant grafts (TVGs) [including living donor (LD) and deceased donor split/partial grafts] on waitlist (WL) and transplant outcomes for pediatric liver transplant (LT) candidates, we performed a retrospective analysis of Organ Procurement and Transplantation Network (OPTN) data on first-time LT or liver-kidney pediatric candidates listed at centers that performed >10 LTs during the study period, 2004-2020. Center variance was plotted for LT volume, TVG usage, and survival. A composite center metric of TVG usage and WL mortality was developed to demonstrate the existing variation and potential for improvement. Sixty-four centers performed 7842 LTs; 657 children died on the WL. Proportions of WL mortality by center ranged from 0% to 31% and those of TVG usage from 0% to 76%. Higher TVG usage, from deceased donor or LD, independently or in combination, significantly correlated with lower WL mortality. In multivariable analyses, death from listing was significantly lower with increased center TVG usage (HR = 0.611, CI: 0.40-0.92) and LT volume (HR = 0.995, CI: 0.99-1.0). Recipients of LD transplants (HR = 0.637, CI: 0.51-0.79) had significantly increased survival from transplant compared with other graft types, and recipients of deceased donor TVGs (HR = 1.066, CI: 0.93-1.22) had statistically similar outcomes compared with whole graft recipients. Increased TVG utilization may decrease WL mortality in the US. Hence, policy and training to increase TVG usage, availability, and expertise are critical.

OPTN/SRTR 2021 Annual Data Report: Heart

The past 5 years have posed challenges to the field of heart transplantation. The 2018 heart allocation policy revision was accompanied by anticipated practice adjustments and increased use of short-term circulatory support, changes that may ultimately serve to advance the field. The COVID-19 pandemic also had an impact on heart transplantation. While the number of heart transplants in the United States continued to increase, the number of new candidates decreased slightly during the pandemic. There were slightly more deaths following removal from the waiting list for reasons other than transplant during 2020, and a decline in transplants among candidates listed as status 1, 2, or 3 compared with the other statuses. Heart transplant rates decreased among pediatric candidates, most notably among those younger than 1 year. Despite this, pretransplant mortality has declined for both pediatric and adult candidates, particularly candidates younger than 1 year. Transplant rates have increased in adults. The prevalence of ventricular assist device use has increased among pediatric heart transplant recipients, while the prevalence of short-term mechanical circulatory support, particularly intra-aortic balloon pump and extracorporeal membrane oxygenation, has increased among adult recipients.

OPTN/SRTR 2021 Annual Data Report: Kidney

The year 2021 marked both successes and challenges for the field of kidney transplantation, in the context of the ongoing COVID-19 pandemic and broader geographic organ distribution. The total number of kidney transplants in the United States reached a record count of 25,487, driven by growth in deceased donor kidney transplants. The total number of candidates listed for deceased donor kidney transplant rose slightly in 2021 but remained below 2019 listing levels, with nearly 10% of candidates having been waiting 5 years or longer. Pretransplant mortality declined slightly among candidates of Black, Hispanic, and other races, in parallel with increasing numbers of Black and Hispanic transplant recipients. In the context of broader organ sharing, there is growing disparity in pretransplant mortality among non-metropolitan compared with metropolitan residents. The proportion of deceased donor kidneys recovered but not used for transplant (nonuse rate) rose to a high of 24.6% overall, with greater nonuse among biopsied kidneys (35.9%), kidneys from donors aged 55 years or older (51.1%), and kidneys with kidney donor profile index (KDPI) of 85% or greater (66.6%). Nonuse of kidneys from donors who are hepatitis C virus (HCV) anti-body positive only slightly exceeded that of HCV antibody–negative donors. Disparities in access to living donor kidney transplant persists, especially for non-White and publicly insured patients. Delayed graft function continues an upward trend and occurred in 24% of adult kidney transplants in 2021. Five-year graft survival after living compared with deceased donor transplant was 88.6% versus 80.7% for recipients aged 18-34 years, and 82.1% versus 68.0% for recipients aged 65 years or older. The total number of pediatric kidney transplants performed increased to 820 in 2021, the highest number since 2010. Despite numerous efforts, living donor kidney transplant remains low among pediatric recipients, with continued racial disparities. The rate of deceased donor transplants among pediatric candidates recovered in 2021 from a low in 2020. Congenital anomalies of the kidney and urinary tract remain the leading primary kidney disease diagnosis among pediatric candidates. Most pediatric deceased donor recipients receive a kidney from a donor with KDPI less than 35%. Graft survival continues to improve, with superior outcomes for living donor transplant recipients.

The Impact of Ex Situ Heart Perfusion in Pediatric Transplantation: An Analysis of the United Network for Organ Sharing Registry.

Ex situ heart perfusion (ESHP) has increased the pool of donors in adults. However, this is not true in pediatrics due to lack of devices. Therefore, we sought to understand organ refusal in pediatrics and estimate donor heart usage with ESHP. Donor hearts offered to pediatrics were identified from the United Network for Organ Sharing (UNOS) Database (2000-2019). A linear regression model was built to predict average travel speed, and the extended maximum permitted distance with ESHP was calculated. This extended distance was compared with the policy for maximum travel distance. There were 33,708 donor offers (n = 10,807 hearts) to pediatric programs (24.1% [n = 2,604] transplanted). Six percent of the offers (n = 1,832) (n = 771 hearts) were turned down due to distance, with 676 of the hearts never transplanted. Based on the modeling and using an ESHP time of 5.5 hours, 84% (n = 570/676) of hearts turned down as distance could be utilized by pediatric programs. This proportion increased to 100% with 10 hours of support time. By addressing prolonged ischemic time due to distance, ESHP has the potential to increase the number of donors utilized in pediatric candidates. While no device exists for pediatrics, this analysis lends support to the importance of developing this technology.

A North American, single-center experience implanting fenestrated atrial devices and atrial flow regulators into a heterogeneous group of pediatric pulmonary hypertension patients.

The clinical deterioration commonly experienced by pediatric patients with pulmonary arterial hypertension (PAH) has motivated a shift in the treatment of pulmonary hypertension (PH) through innovations in surgical salvage interventions. The Occlutech fenestrated atrial septal defect (FASD) Occluder and the atrial flow regulator (AFR), which provides a protective, atrial-level shunt during hypertensive crises, have found an important role in treating pediatric patients with PAH. Other groups of pediatric patients with PH may also benefit from a similar protective physiology. The primary aim of this work is to present a single center's experience with AFR and FASD devices for managing a heterogeneous group of pediatric PH patients. A secondary goal is to identify hemodynamic changes and complications following device implantation. We performed a retrospective review of all pediatric PH patients who, after being found suitable, either successfully or unsuccessfully received an FASD or AFR device between January 2015 and December 2021 at the Stollery Children's Hospital in Edmonton, Canada. Fourteen patients (eight female) with a median age of 4.6 (range 0.3-17.9) years and a median body mass index of 15.1 (Q1 = 13.8, Q3 = 16.8) kg/m2 underwent device implantation: five received FASDs, eight received AFRs, and one was ultimately unable to receive an implant due to thrombosed iliac vessels and required surgical intervention. Of the fourteen patients, seven were in group 1 (PAH), one was in group 3 (lung disease), and six were in group 5 (primarily pulmonary hypertension vascular disease) under the World Symposium PH classification. All patients were on mono-, dual-, or triple-drug PH therapy. Device stabilization was not possible for two patients, who then required a repeat catheterization. Of the group 1 patients, three AFR and three FASD implants were successful, while one FASD implant was unsuccessful due to thrombosed vessels. At a six-month clinical assessment, all group 1 patients had patent devices and improved WHO FCs. This work presents a single center's experience with AFR and FASD implants in a heterogeneous group of fourteen pediatric patients with severe PH. This treatment strategy is novel in the pediatric population and so this work provides momentum for future studies of interventional cardiac catheterization procedures for pediatric patients with PH. Further collaborations are required to develop criteria to identify ideal pediatric candidates and optimally time interventions in order to maximize the benefits of this treatment.

Waitlist mortality in pediatric liver transplantation: The goal is zero.

Waitlist mortality in pediatric liver transplantation: The goal is zero.

Comparative Study of the Effect of Oral Chloral Hydrate and Intranasal Fentanyl on Sedation in Children for Electroencephalography.

Sedation and stability during electroencephalography (EEG) in pediatrics have high clinical importance. This study compares the sedative properties of oral chloral hydrate (OCH) and intranasal fentanyl (INF). This study was a randomized clinical trial conducted in 2020 in Isfahan City on sixty-two pediatric candidates for EEG. Patients were randomized into two groups receiving 50 mg/kg OCH and 2 μg/kg INF thirty minutes before the process. The heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), and oxygen saturation (O2 sat) of patients, sedation, and physician's satisfaction were measured and compared between groups. The HR of patients decreased significantly in both groups (P< 0.001), and the patients that received INF had significantly lower HR 15, 30, 45, and 60 minutes after drug administrations (P< 0.05). RR evaluation indicated significantly decreased RR in both groups (P< 0.001), and patients receiving INF had lower RR 30, 45, and 60 per minutes after drug administrations (P< 0.001). Both groups showed significantly increased sedation levels during the study (P< 0.001), and patients treated with INF had higher sedation levels 15, 30, and 45 minutes after drug administration. Satisfaction rates were higher among the group that received INF (P= 0.020). The use of INF had significant analgesic and sedative effects on pediatrics undergoing EEG.

Deceased donor organ allocation in pediatric transplantation: Ahistorical narrative.

Since the earliest clinical successes in solid organ transplantation, the proper method of organ allocation for children has been a contentious subject. Over the past 30-35years, the medical and social establishments of various countries have favored some degree of preference for children on the respective waiting lists. However, the specific policies to accomplish this have varied widely and changed frequently between organ type and country. Organ allocation policies over time were examined. This review traces the reasons behind and the measures/principles put in place to promote early deceased donor transplantation in children. Preferred allocation in children has been approached in a variety of ways and with varying degrees of commitment in different solid organ transplant disciplines and national medical systems. The success of policies to advantage children has varied significantly by both organ and medical system. Further work is needed to optimize allocation strategies for pediatric candidates.

Pediatric Tuberculosis Diagnostics: Present and Future.

The current diagnostic abilities for the detection of pediatric tuberculosis are suboptimal. Multiple factors contribute to the under-diagnosis of intrathoracic tuberculosis in children, namely the absence of pathognomonic features of the disease, low bacillary loads in respiratory specimens, challenges in sample collection, and inadequate access to diagnostic tools in high-burden settings. Nonetheless, the 2020s have witnessed encouraging progress in the area of novel diagnostics. Recent WHO-endorsed rapid molecular assays hold promise for use in service decentralization strategies, and new policy recommendations include stools as an alternative, child-friendly specimen for testing with the GeneXpert assay. The pipeline of promising assays in mid/late-stage development is expanding, and novel pediatric candidate biomarkers based on the host immune response are being identified for use in diagnostic and triage tests. For a new test to meet the pediatric target product profiles prioritized by the WHO, it is key that the peculiarities and needs of the hard-to-reach pediatric population are considered in the early planning phases of discovery, validation, and implementation studies.

413.5: HCV-Viremic Donor Allograft Consideration by Organ Type And Year, Among Adult and Pediatric Solid Organ Transplant Candidates

Introduction: Use of HCV-viremic donor organs (D+) for transplant into HCV-seronegative recipients (R-) has been shown to be safe and equally effective as using HCV-seronegative donor organs since 2016. Therefore, we sought to evaluate changes in frequency of transplant candidates being listed as willing to consider offers of HCV-viremic donor organs (“HCV offer interest”) from 2015-2021 as a measure of greater openness to HCV D+/R- transplants among transplant candidates and centers. Methods: We identified all waitlist candidates 2015-2021 listed for kidney, liver, heart, or lung transplantation in the United States using the Scientific Registry of Transplant Recipients. Waitlist candidate HCV serostatus was not available, but the proportion of waitlist additions for HCV-related disease in the United States is declining. We compared patient and center characteristics using Chi-square and McNemar tests, by HCV offer interest, for pediatric (<18 years old) and adult transplant candidates. Results: We identified 392,515 waitlist candidates (269,770 kidney, 69,728 liver, 32,418 heart, 20,599 lung), including 377,375 adult and 15,140 pediatric candidates. Overall, 33.8% of adult and 4.1% of pediatric candidates were recorded as interested in HCV D+ organ offers (p<0.001, Table 1). HCV offer interest varied by organ type among both adult (30.3% kidney vs. 42.3% liver vs. 45.0% heart vs. 35.3% lung, p<0.001) and pediatric candidates (2.0% kidney vs. 3.0% liver vs. 7.3% heart vs. 12.9% lung, p<0.001). All organ types showed increased HCV offer interest over time (Figure 2). The percentage of transplant centers who had at least one pediatric candidate listed as interested in HCV D+ offers had a trend toward an increased from 2015 to 2021 for kidney (4.5% vs. 12.1%, p=0.07), liver (3.6% vs. 9.4%, p=0.06), heart (7.1% vs. 16.1%, p=0.1), and lung candidates (12.0% vs. 33.3%, p=0.5). The percentage of transplant centers who had at least one adult candidate listed as interested in HCV D+ organ offers remained stable from 2015 to 2021 for kidney (74.2% vs. 77.4%, p=0.8) and liver (92.4% vs. 93.4%, p>0.9) candidates and increased for heart (48.6% vs. 72.1%, p<0.001) and lung (31.8% vs. 58.9%, p<0.001) candidates. Conclusion: Willingness to consider HCV-viremic donor organs has increased since 2015 at the patient and center levels among pediatric and adult candidates, especially pediatric lung transplant candidates. This reflects the increasing recognition of the safety and efficacy of HCV-viremic organ transplants into HCV-seronegative recipients. However, a substantial percentage of transplant centers still have no candidates listed as willing to consider HCV-viremic donor offers, possibly indicating a lack of comfort with HCV D+/R- transplants. We must address this discomfort with educational initiatives to ensure this valuable organ pool is available to as many waitlist candidates as possible. F32 AG067642-01A1 (National Institutes of Aging).

Imaging in Craniofacial Disorders With Special Emphasis on Gradient Echo Black-Bone and Zero Time Echo MRI Sequences.

The well-known effects of ionizing radiation on brain cells have been a major driving force toward the use of non-ionizing methods of imaging in both elective and emergency settings. Pediatric neurosurgery has certainly leveraged on this shift in clinical practice, however patients with craniofacial disorders could not fully benefit from the adoption of magnetic resonance imaging (MRI) because computed tomography (CT) scans still retain superior imaging power on bone tissue. To explore the knowledge available on the use of MRI as surrogate for CT scan in the assessment of craniosynostosis. A scoping review was designed to identify landmark studies and ongoing clinical trials exploring the accuracy of MRI-based bone imaging in the preoperative planning of pediatric patients with craniosynostosis. A total of 492 records were screened from Pubmed, Ovid Medline, Scopus, and Cochrane Library databases; while 55 records were retrieved from ClinicalTrials.gov register. Only clinical studies revolving around the use of Gradient Echo Black-Bone (BB) and Zero Time Echo (ZTE) MRI sequences for the preoperative planning of pediatric craniosynostosis were retained for inclusion. This review identified only five clinical studies reporting a high accuracy of MRI-based 3D bone reconstruction in 47 pediatric candidates to surgical correction of craniosynostosis. Although promising, limited evidence (Level IV) exist that BB and ZTE MRI could help in the surgical planning for craniosynostosis management. The results of two ongoing randomized clinical trials, which are actively enrolling patients, will hopefully help answering this research question.

Access to kidney transplantation among pediatric candidates with prior solid organ transplants in the United States.

Pediatric kidney transplant candidates require timely access to transplant to optimize growth and neurodevelopmental outcomes. We studied access to transplant for pediatric candidates with prior organ transplants. We used US registry data to identify pediatric kidney transplant candidates added to the waiting list 2015-2019 and used competing risk regression to study the association between prior transplant status and probability of receiving a kidney transplant, treating wait-list removal and death as competing events. Of 4962 pediatric kidney transplant candidates included, 89% had no prior transplant and 11% had received a prior organ transplant (kidney 87%, liver 5%, heart 5%). Prior transplant recipients were older at listing (median 15 vs. 12 years) and more likely to have PRA≥98% (22% vs. 0.3%) (both p < .001). There was no significant difference in the proportion of candidates from each group who were preemptively wait-listed. Unadjusted competing risk regression showed a lower risk of kidney transplant after wait-listing among candidates with prior organ transplant (HR 0.52, 95%CI 0.47-0.59, p < .001). This association remained significant after adjusting for candidate characteristics (HR 0.73, 95%CI 0.63-0.83, p < .001). Among deceased donor kidney recipients, median KDPI was similar between groups, but recipients with prior transplants were more likely to receive kidneys from donors with hypertension (4% vs. 1%, p=.01) and donors after cardiac death (11% vs. 4%, p < .001). Pediatric kidney transplant candidates with prior organ transplants have reduced access to transplant after wait-listing. Allocation system changes are needed to improve timely access to transplant for this vulnerable group.

Impact of the 2018 Adult Heart Allocation Change on Pediatric Donor Offers and Waitlist Outcomes

<h3>Purpose</h3> On October 18, 2018, UNOS made important revisions to the adult allocation system for heart transplant (HT). Although the revisions primarily affect the prioritization of adult HT candidates, it could impact pediatric candidates indirectly as adult candidates listed Status 1 or 2 take priority over pediatric Status 1B and 2 candidates. We sought to determine if there was any effect on donor offers, declines and waitlist outcomes for pediatric candidates in light of the adult allocation change. <h3>Methods</h3> All children <18 listed for HT within a 2-year period before and after the adult allocation revision was implemented were identified using OPTN data. Match-run analysis was also performed to examine the offer and decline rates. The primary endpoints were candidate transplantation and mortality rates. <h3>Results</h3> A total of 2,397 children met the study inclusion criteria, including 1,295 children listed before and 1,102 children listed after the adult policy change. The two cohorts were similar with respect to age, weight, cardiac diagnosis, ECMO, ventilator, VAD use, and insurance status. Nationwide offers to pediatric 1A candidates increased 34% per day, though center rejection of offers also rose a similar amount (41%). Pediatric candidates listed Status 1B and 2 also received more offers with a similar rise in center rejections, though the increases were smaller than for 1A candidates. Transplantation and mortality within 30-, 60- and 90-days did not change for 1A/1B candidates perhaps owing to the concomitant rise in center rejections of offers. There was a modest but significant decline in the likelihood of 30- and 60-day transplantation for patients listed at Status 2 following the change, though the likelihood of 90-day transplantation was comparable. <h3>Conclusion</h3> The 2018 changes to the adult allocation system have, if anything, resulted in an increased flow of donor offers to pediatric candidates, however transplantation rates for children listed 1A and 1B appear similar before and after the change, partly because the rise in offers was associated with a rise in offer rejections. For pediatric Status 2 candidates, transplantation was slightly lower at 30- and 60-days, but comparable at 90 days. More work is needed to reduce offer rejections to increase the transplantation rate for pediatric HT candidates.

Association Between Donor Age and Posttransplant Mortality in Pediatric Lung Recipients: A 10-Year Nationwide Cohort Study

<h3>Purpose</h3> To address the shortage of pediatric donor lungs the French lung allocation system assigns priority status to pediatric candidates. Consequently, pediatric candidates frequently receive organ from adult donors. An association between donor age and posttransplant mortality has been shown in adult lung recipients. This study aimed to evaluate the effect of donor age on posttransplant mortality in pediatric lung recipients <h3>Methods</h3> All candidates registered on the national waiting list before 18 years old between January, 1^st 2010 and December 31^st 2020 who underwent transplantation were included in this cohort study using the national registry Cristal. Recipient characteristics at transplant in addition to donor characteristics were analyzed. 1-year posttransplant survival was estimated by the Kaplan-Meier method. Cubic spline model was used to evaluate the association between donor age as continuous variable and 1-year posttransplant mortality. <h3>Results</h3> Of the 121 transplant recipients (55 males, 11+ years n=110, cystic fibrosis n=76, pulmonary fibrosis n=28, pulmonary hypertension n=14, bronchiectasis n=3) 21 were on extracorporeal membrane oxygenation (ECMO), 4 on mechanical ventilation without ECMO at transplant. Among donors, 76 were female, cerebrovascular accident and head trauma were the cause of death in 60 and 35 respectively, 17 had PaO2/FiO2 ratio <350 mmHg, 56 were CMV-positive, 40 had cardiopulmonary resuscitation and 96 (79%) were >17 years old. One-year posttransplant survival was 82%. Pretransplant ECMO and mechanical ventilation without ECMO, and donor-recipient height ratio >1.2 were associated with posttransplant mortality. Donor age was not associated with hazard ratio for 1-year mortality (Figure). <h3>Conclusion</h3> Allocation of adult donor lungs to elective and urgent pediatric candidates through pediatric priority status can address the shortage of pediatric donor organs without affecting posttransplant outcomes.

Effect of Donor Age on Posttransplant Mortality in Pediatric Heart Transplant Recipients: A 10-Year Nationwide Cohort Study

<h3>Purpose</h3> The French heart allocation system prioritizes pediatric over adult candidates. This policy seeks to address the shortage of pediatric donor hearts. Consequently, pediatric candidates frequently receive organ from adult donors. An association between donor age and posttransplant mortality has been shown in adult heart recipients. This study aimed to evaluate the effect of donor age on posttransplant mortality in pediatric heart recipients. <h3>Methods</h3> All candidates registered on the national waiting list before 18 years old between January, 1^st 2010 and December 31^st 2020 who underwent transplantation were included in this cohort study using the national registry Cristal. Recipient characteristics at transplant in addition to donor characteristics were analyzed. The main outcome was 1-year posttransplant survival estimated with Kaplan-Meier method. Relationship between donor age and 1 year mortality was assessed with a Cox proportional hazard model with donor age as a continuous variable transformed with restricted cubic splines. <h3>Results</h3> Of the 274 transplant recipients (148 males, <6 years n=69, 6-10 years n=47, 11+ years n=158, cardiomyopathy n=174, congenital heart disease n=46, retransplantation n=13, other n=41) 115 were on inotropic infusion, 32 on short-term mechanical support (MCS) and 45 on long-term MCS at transplant. Among donors, 129 were female, head trauma was the cause of death in 132, 101 had cardiopulmonary resuscitation and 159 (58%) were >17 years old. One-year posttransplant survival was 93%. Congenital heart disease and retransplantation were associated with posttransplant mortality. Donor age was not associated with hazard ratio for 1-year mortality (Figure). <h3>Conclusion</h3> Allocation of adult donor hearts to elective and urgent pediatric candidates through pediatric priority statutes can address the shortage of pediatric donor organs without affecting posttransplant outcomes.

Examination of Racial and Socioeconomic Disparity in Use of Nondirected Kidney Donation in the US.

Nondirected donor (NDD) kidney transplant (NDDKT) continues to improve organ access for waitlisted candidates. Although NDDs are becoming increasingly common, there has been no contemporary evaluation of NDD allograft use, and it is vital to understand sociodemographic, as well as center-level, use across the US. Using national data from the Scientific Registry for Transplant Recipients, this study characterized NDDs, NDDKT recipients, and center-level distribution of NDDKT. Directed donor and NDD characteristics were compared using Fisher's exact and Wilcoxon rank-sum tests for categorical and continuous variables, respectively. Multivariable logistic regression was used to identify characteristics associated with receiving NDDKT, and center distribution of NDDKT was assessed using the Gini coefficient. NDDKT increased from 1.4% (n = 154) of all living donor kidney transplants in 2010 to 6.5% (n = 338) in 2020. Compared with directed living donors, NDDs were older (median [IQR], 44 [33 to 54] vs 43 [33 to 52], p < 0.01), more often male (40.2% vs 36.7%, p < 0.001), and White (91.4% vs 69.5%, p < 0.001). White adult candidates were more likely to receive NDDKT compared with Black (adjusted odds ratio [aOR], 0.300.340.39, p < 0.001), Hispanic/Latino (aOR, 0.360.420.48, p < 0.001), and Other (aOR, 0.410.470.55, p < 0.001) candidates. Black pediatric candidates had lower odds of receiving NDDKT (aOR, 0.090.220.54, p = 0.02). The proportion of centers performing NDDKT has increased from 2010 to 2020 (Gini = 0.77 vs 0.68). Although more centers are performing NDDKT, racial disparities persist among NDDs and NDDKT recipients. Continued effort is needed to recruit living kidney donors and improve access to living donation for minority groups in the US. (J Am Coll Surg 2022;234:000-00. © 2022 by the American College of Surgeons).

OPTN/SRTR 2020 Annual Data Report: Introduction

OPTN/SRTR 2020 Annual Data Report: Introduction

OPTN/SRTR 2020 Annual Data Report: COVID

OPTN/SRTR 2020 Annual Data Report: COVID