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Prolonged preservation of human pediatric hearts for transplantation: correlation of ischemic time and subsequent
M Kawauchi1, S R Gundry, J A de Begona
1Department of Surgery, Loma Linda University Medical Center, CA 92354.
Insights
Pediatric heart transplant recipients tolerated donor hearts with ischemic times up to 8.5 hours. This study found no significant differences in graft failure or recovery based on donor heart ischemic duration.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Pediatric heart transplantation is a life-saving procedure for end-stage heart failure.
- Optimizing donor organ utilization is crucial, especially regarding ischemic time.
Purpose of the Study:
- To evaluate the impact of donor heart ischemic time on outcomes in pediatric heart transplantation.
- To determine the safety and efficacy of extended ischemic times in this patient population.
Main Methods:
- Retrospective study of 91 infants and children (0-12 years) receiving 93 heart transplants.
- Donor hearts were analyzed based on ischemic time: Group 1 (<4 hours) and Group 2 (>4 hours).
- Outcomes assessed included graft failure, inotropic support, ventilator status, and echocardiographic parameters (posterior wall movement, fractional shortening).
Main Results:
- No significant difference in donor/recipient age or weight ratio between groups.
- Ischemic time did not correlate with primary graft failure.
- A transient decrease in posterior wall movement was observed in Group 2 at 1 week post-transplant, but recovered by week 2.
- Fractional shortening improved significantly from week 1 to week 2 in both groups.
Conclusions:
- Donor heart ischemic times up to 8.5 hours are well-tolerated in pediatric heart transplantation.
- Extended ischemic times do not appear to negatively impact short-term graft function or survival.
Abstract:
Ninety-one infants and children, aged 0 days to 12 years, who received 93 hearts from donors aged 2 days to 24 years between November 1985 and September 1990 were retrospectively studied. Forty-three children were less than 1 month of age; 31 children were between 1 month and 6 months of age, and 19 children were between 6 months and 12 years of age. The donor heart ischemic time ranged from 51 minutes to 8 hours 17 minutes (mean, 4 hours 2 minutes). Fifty-one hearts had an ischemic time of less than 4 hours (group 1), and 42 hearts, more than 4 hours (group 2). No significant difference was noted in the age of donor or recipient or in donor/recipient weight ratio. No correlation was found between ischemic time and number of primary graft failures between groups. Inotropic support was required for 3.9 +/- 3.3 and 5.2 +/- 3.7 days for group 1 versus group 2 (not significant). Ventilator status was the same between the groups. A significant decrease of posterior wall movement in diastole (p < 0.01) occurred among patients of group 2 at 1 week after transplantation, but no difference was found between groups at 2 weeks, 1 month, and 3 months after operation. Posterior wall movement of group 2 heart grafts recovered completely by week 2. No difference was noted in the fractional shortening between the groups; but in both groups, fractional shortening significantly increased from week 1 to week 2. We conclude that ischemic times up to nearly 8 1/2 hours are well tolerated by donor hearts used in pediatric transplantation.