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Published on: August 15, 2022
Duration of graft cold ischemia does not affect outcomes in pediatric heart transplant recipients
Albertus M Scheule1, Grenith J Zimmerman, Joyce K Johnston
1Department of Surgery, Loma Linda University School of Medicine, and Children's Hospital, Loma Linda, Calif, USA.
Insights
Utilizing donor hearts with prolonged graft ischemia (>8 hours) did not adversely affect late outcomes in pediatric heart transplant recipients. This approach may help expand the donor pool for life-saving procedures.
Area of Science:
- Cardiology
- Transplantation Surgery
- Pediatric Medicine
Background:
- Expanding the donor heart pool is crucial for pediatric heart transplantation.
- Prolonged graft ischemia is a limiting factor in organ utilization.
Purpose of the Study:
- To evaluate the impact of prolonged ischemic times on outcomes in pediatric heart transplant recipients.
- To determine if donor hearts preserved with extended cold ischemia impact long-term graft survival and post-transplant complications.
Main Methods:
- Retrospective review of 363 pediatric heart transplant recipients (aged 1 day to 17 years).
- Comparison of outcomes between recipients of hearts with prolonged ischemic times (>8 hours) and short ischemic times (<=90 minutes).
- Analysis of graft survival, rejection episodes, hospital readmissions, and development of post-transplant coronary artery disease.
Main Results:
- No significant differences in actuarial graft survival between prolonged ischemic time (PIT) and short ischemic time (SIT) groups.
- Similar rates of rejection episodes and hospital readmissions in the first post-transplantation year for both groups.
- Cardiopulmonary bypass time was significantly longer in the PIT group.
Conclusions:
- Donor hearts preserved with single-dose cold crystalloid cardioplegia and prolonged cold ischemia (>8 hours) do not adversely affect late outcomes in pediatric heart transplant recipients.
- This finding supports the potential to expand the donor pool by utilizing organs with extended preservation times.
- Late outcomes, including graft survival and complication rates, were comparable between groups.
Background:
Utilizing donor hearts with prolonged graft ischemia may extend the donor pool.
Methods And Results:
The medical records of 363 infants and children, aged 1 day to 17 years, transplanted at Loma Linda University between November 1985 and March 2001, were retrospectively reviewed. Fourteen children received organs with prolonged ischemic times (>8 hours)(PIT) compared with 14 with short ischemic times (< or =90 minutes)(SIT). There were no significant differences when comparing donors for gender, age, weight, cause of death, or duration of cardiopulmonary resuscitation. Preoperative donor shortening fraction (%), as determined by echocardiography, was significantly higher in the SIT group (44.5 versus 36.5%; P=0.006). There were no significant differences between PIT and SIT recipients when comparing age at transplant, weight at transplant, waiting time, weight mismatch, postoperative days on ventilator, duration of inotropic support, and hospital stay. Cardiopulmonary bypass time was significantly longer in the PIT group (140.5 versus 80.5 minute; P=0.001). Median length of follow-up for both groups was approximately 5 years. Five grafts were lost in the PIT group; 7 were lost in the SIT group, with 1 early graft loss in each group. Significant posttransplant coronary artery disease was diagnosed in 2 recipients in each group (PIT: 80 and 42; SIT: 84 and 67 months posttransplant). There was no significant difference between groups in actuarial graft survival. Number of rejection episodes and hospital readmissions during the first posttransplantation year did not differ significantly between groups.
Conclusion:
Late outcomes were not adversely affected by donor hearts preserved by single dose cold crystalloid cardioplegia with greater than 8 hours of cold ischemia.
