Successful outcome with extended allograft ischemic time in pediatric heart transplantation.
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).


CONCLUSIONS
Procurement of hearts from distant locations with associated extended DIT is justified in the setting of increased demand and a fixed donor population.
Morgan
Jeffrey A
JA
Department 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
John
Ranjit
R
Park
Yookyung
Y
Addonizio
Linda J
LJ
Oz
Mehmet C
MC
Edwards
Niloo M
NM
Quaegebeur
Jan M
JM
Mosca
Ralph S
RS
D000293:Adolescent; D009202:Cardiomyopathies / Q000453:epidemiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery; D006333:Heart Failure / Q000453:epidemiology / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous; D052096:Warm Ischemia