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Posttransplant outcomes with prolonged donor heart ischemic time in the pediatric population
Shannon Oliver1, Jennifer Conway1, Michael Khoury1
1Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Insights
Pediatric heart transplant (HTx) outcomes are not negatively impacted by longer ischemic times (IT). This study found no increased risk of graft failure or morbidity with ischemic times exceeding 6 hours in heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Surgery
- Pediatric Medicine
Background:
- Current guidelines advise against using donor hearts with ischemic times (IT) exceeding 6 hours for pediatric heart transplantation (HTx).
- Limited data exists on the impact of prolonged IT on pediatric HTx outcomes, particularly from geographically remote centers.
Purpose of the Study:
- To evaluate the association between ischemic time (IT) and clinical outcomes in pediatric heart transplant (HTx) recipients.
- To determine if IT is an independent risk factor for graft failure or morbidity in this population.
Main Methods:
- Retrospective single-center analysis of 188 pediatric patients undergoing heart transplantation between January 1995 and December 2020.
- Patients were categorized into three IT groups: <4.5 hours, 4.5-6 hours, and >6 hours.
- Cox proportional hazard modeling was used to assess factors associated with graft failure.
Main Results:
- Ischemic time was evenly distributed across the cohort (37.2% vs 31.4% vs 31.4%).
- No significant differences in early post-HTx morbidity, including primary graft dysfunction, were observed among the IT groups.
- Prolonged IT (>6 hours) was not associated with an increased risk of graft failure compared to IT <4.5 hours (HR 1.10, P = .797).
Conclusions:
- In this cohort, ischemic time was not an independent risk factor for post-heart transplant morbidity or graft failure.
- The use of a modified del Nido preservation solution and institutional experience may contribute to successful outcomes with prolonged IT.
Abstract:
Avoiding grafts with ischemic time (IT) >6 hours continues to be advised in pediatric heart transplant (HTx). We sought to evaluate the association between IT and clinical outcomes in a geographically remote center. This was a retrospective single-center analysis of patients transplanted between January 1995 and December 2020. Baseline characteristics and post-HTx outcomes were compared across 3 IT groups (<4.5 hours, 4.5-6 hours, and >6 hours) with results reported in that order. Cox proportional hazard modeling was used to determine factors associated with graft failure. Of the 188 patients, 56.4% were men, the median age was 3.0 years (interquartile range, 0.6, 10.2 years), and 46.3% had congenital heart disease. IT was evenly distributed among the cohort (37.2% vs 31.4% vs 31.4%). There were no differences in early post-HTx morbidity, including primary graft dysfunction (2.9% vs 1.7% vs 5.3%, P = .5). Compared with IT <4.5 hours, longer IT was not associated with graft failure (IT 4.5-6 hours: hazard ratio, 1.10 [0.50-2.39]; P = .810 and [IT >6 hours: hazard ratio 1.10 {0.52-2.35}]; P = .797). In our population, IT was not an independent risk factor for post-HTx morbidity or graft failure. Use of a modified del Nido preservation solution and experience with prolonged IT donors may have contributed to our outcomes.
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