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Successful outcome with extended allograft ischemic time in pediatric heart transplantation
Jeffrey A Morgan1, Ranjit John, Yookyung Park
1Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, New York, NY 10032, USA. jm2240@columbia.edu
Insights
Extended donor ischemic time (DIT) does not significantly impact survival rates in pediatric heart transplant recipients. This finding supports the use of distant donor hearts to meet the growing demand for pediatric cardiac transplants.
Area of Science:
- Cardiology
- Transplantation Immunology
- Pediatric Surgery
Background:
- Cardiac transplant programs are liberalizing donor criteria to increase organ supply.
- Prolonged donor ischemic time (DIT) effects are well-studied in adults, but less so in pediatric recipients.
- This study addresses the impact of extended DIT on pediatric heart transplant outcomes.
Purpose of the Study:
- To evaluate the effect of prolonged donor ischemic time (DIT) on post-transplant mortality in pediatric heart transplant recipients.
- To determine if extended DIT is an independent predictor of mortality in this population.
Main Methods:
- Retrospective review of 129 pediatric heart transplant cases over 11 years.
- Comparison of outcomes between patients with DIT >240 minutes and DIT <240 minutes.
- Statistical analysis using Cox proportional hazard models.
Main Results:
- No significant differences in patient or donor demographics between groups.
- Similar 1, 5, and 10-year post-transplant survival rates for both DIT groups (p=0.433).
- Extended DIT (>240 minutes) was not a significant independent predictor of post-transplant mortality (OR 0.655).
Conclusions:
- Extended donor ischemic time is not associated with increased mortality in pediatric heart transplantation.
- Procuring hearts from distant donors, even with extended DIT, is justifiable given organ demand.
- This supports broader donor acceptance criteria to maximize the donor pool for pediatric recipients.
Background:
Many cardiac transplant programs have liberalized donor eligibility criteria in an attempt to maximize donor supply and to accommodate increasing demand. Although many studies have evaluated the potential adverse effects of prolonged donor ischemic time (DIT) in adults undergoing cardiac transplantation, relatively few have focused specifically on pediatric recipients that include a substantial number of patients and long-term follow-up. The focus of this study was to examine the effect of extended DIT on mortality after pediatric heart transplantation.
Methods:
We conducted a retrospective review of our pediatric cardiac transplant experience in the past 11 years, comparing patients who received allografts and had ischemic times >240 minutes with those who had ischemic times <240 minutes.
Results:
A total of 129 pediatric patients (<19 years) underwent orthotopic heart transplantation, of whom 78 (60.5%) had DIT <240 minutes and 51 (39.5%) had DIT >240 minutes. We found no statistically significant difference in age, sex, race, height, weight, or donor age between the groups (p = not significant). Post-transplant survival at 1, 5, and 10 years was similar for both groups: 91.2%, 88.0%, and 85.2%, respectively, for patients with DIT <240 minutes vs 89.6%, 87.2%, and 79.8%, respectively, for patients with DIT >240 minutes (p = 0.433). Additionally, using Cox proportional hazard models, extended DIT >240 minutes was not a statistically significant independent predictor of post-transplant mortality (odds ratio, 0.655; 95% confidence interval, 0.518-0.972; p = 0.684; standard error = 0.468).
Conclusion:
Procurement of hearts from distant locations with associated extended DIT is justified in the setting of increased demand and a fixed donor population.
