In this issue of the Journal, Profita and colleagues report findings from a well-controlled analysis matching outcomes from the Organ Procurement and Transplantation Network (OPTN) and the Extracorporeal Life Support Organization (ELSO) datasets to identify incidences of and risk factors for severe primary graft dysfunction (PGD) in pediatric heart transplant recipients within the United States.1 The authors find no change in the incidence of severe PGD across two decades of pediatric heart transplant.