title: Total donor ischemic time: relationship to early hemodynamics and intensive care morbidity in pediatric cardiac transplant recipients.
abstract: OBJECTIVE
  Single-center studies have failed to link modest increases in total donor ischemic time to mortality after pediatric orthotopic heart transplant. We aimed to investigate whether prolonged total donor ischemic time is linked to pediatric intensive care morbidity after orthotopic heart transplant.
  
  
  METHODS
  Retrospective cohort review.
  
  
  METHODS
  Tertiary pediatric transplant center in the United Kingdom.
  
  
  METHODS
  Ninety-three pediatric orthotopic heart transplants between 2002 and 2006.
  
  
  METHODS
  Total donor ischemic time was investigated for association with early post-orthotopic heart transplant hemodynamics and intensive care unit morbidities.
  
  
  RESULTS
  Of 43 males and 50 females with median age 7.2 (interquartile range 2.2, 13.0) yrs, 62 (68%) had dilated cardiomyopathy, 20 (22%) had congenital heart disease, and nine (10%) had restrictive cardiomyopathy. The mean total donor ischemic time was 225.9 (sd 65.6) mins. In the first 24 hrs after orthotopic heart transplant, age-adjusted mean arterial blood pressure increased (p < .001), mean pulmonary arterial pressure fell (p = .012), but central venous pressure (p = .58) and left atrial pressure (p = .20) were unchanged. After adjustment for age, primary diagnosis, pre-orthotopic heart transplant mechanical support, and marginal donor factors, longer total donor ischemic time was significantly associated with lower mean arterial blood pressure (p < .001) in the first 24 hrs after orthotopic heart transplant, longer post-orthotopic heart transplant mechanical ventilation (p = .03), longer post-orthotopic heart transplant stay in the intensive care unit (p = .004), and longer post-orthotopic heart transplant stay in hospital (p = .02). Total donor ischemic time was not related to levels of mean pulmonary arterial pressure (p = .62), left atrial pressure (p = .38), or central venous pressure (p = .76) early after orthotopic heart transplant.
  
  
  CONCLUSIONS
  Prolonged total donor ischemic time has an adverse effect on the donor organ, contributing to lower mean arterial blood pressure, as well as more prolonged ventilation and intensive care unit and hospital stays post-orthotopic heart transplant, reflecting increased morbidity.
authors.affiliation: Great Ormond Street Hospital for Children NHS Trust, UK.
authors.forename: Warren
authors.initials: W
authors.lastname: Rodrigues
authors.forename: Michelle
authors.initials: M
authors.lastname: Carr
authors.forename: Deborah
authors.initials: D
authors.lastname: Ridout
authors.forename: Katherine
authors.initials: K
authors.lastname: Carter
authors.forename: Sara Louise
authors.initials: SL
authors.lastname: Hulme
authors.forename: Jacob
authors.initials: J
authors.lastname: Simmonds
authors.forename: Martin
authors.initials: M
authors.lastname: Elliott
authors.forename: Aparna
authors.initials: A
authors.lastname: Hoskote
authors.forename: Michael
authors.initials: M
authors.lastname: Burch
authors.forename: Kate L
authors.initials: KL
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007511:Ischemia / Q000150:complications*; D008131:London; D008297:Male; D008485:Medical Audit; D009017:Morbidity / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous; D006113:United Kingdom; D055815:Young Adult