Don Hayes1, Brian F Joy2, Susan D Reynolds3, Joseph D Tobias4, Dmitry Tumin5. 1. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA; Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, Ohio, USA; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA. Electronic address: hayes.705@osu.edu. 2. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA; Section of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA. 3. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA; Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, USA. 4. Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA. 5. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA; Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
Abstract
BACKGROUND: The optimal ischemic time in pediatric lung transplantation (LTx) is unclear, as recent studies have challenged the relevance of 6 hours as an upper limit to acceptable ischemic time. METHODS: Pediatric LTx recipients transplanted between 1987 and 2013 were identified in the United Network for Organ Sharing (UNOS) registry to compare survival according to ischemic time, which was categorized as <4 hours, 4 to 6 hours and >6 hours. RESULTS: Nine hundred thirty patients, all <18 years of age and receiving a first-time LTx from a cadaveric donor, were included in our investigation. Compared with <4 hours of ischemic time, univariate analysis showed a significant reduction in mortality hazard with 4 to 6 hours (hazard ratio [HR] = 0.640; 95% confidence interval [CI] 0.502 to 0.816; p < 0.001) but not >6 hours (HR = 0.985; 95% CI 0.755 to 1.284; p = 0.909). A multivariate Cox model confirmed the lowest mortality hazard to be 4 to 6 hours, as compared with <4 hours (HR = 0.533; 95% CI 0.376 to 0.755; p < 0.001). A prolonged ischemic time of >6 hours was associated with increased mortality hazard relative to the 4 to 6 hours (HR = 1.613; 95% CI 1.193 to 2.181; p = 0.002). Supplementary analyses examining geographic distance between donor and recipient identified no association between geographic distance and recipient mortality hazard. CONCLUSIONS: An ischemic time of 4 to 6 hours was associated with optimal long-term survival in first-time pediatric LTx recipients, whereas a very short ischemic time of <4 hours and a prolonged ischemic time >6 hours were both associated with higher mortality hazard in this population.
BACKGROUND: The optimal ischemic time in pediatric lung transplantation (LTx) is unclear, as recent studies have challenged the relevance of 6 hours as an upper limit to acceptable ischemic time. METHODS: Pediatric LTx recipients transplanted between 1987 and 2013 were identified in the United Network for Organ Sharing (UNOS) registry to compare survival according to ischemic time, which was categorized as <4 hours, 4 to 6 hours and >6 hours. RESULTS: Nine hundred thirty patients, all <18 years of age and receiving a first-time LTx from a cadaveric donor, were included in our investigation. Compared with <4 hours of ischemic time, univariate analysis showed a significant reduction in mortality hazard with 4 to 6 hours (hazard ratio [HR] = 0.640; 95% confidence interval [CI] 0.502 to 0.816; p < 0.001) but not >6 hours (HR = 0.985; 95% CI 0.755 to 1.284; p = 0.909). A multivariate Cox model confirmed the lowest mortality hazard to be 4 to 6 hours, as compared with <4 hours (HR = 0.533; 95% CI 0.376 to 0.755; p < 0.001). A prolonged ischemic time of >6 hours was associated with increased mortality hazard relative to the 4 to 6 hours (HR = 1.613; 95% CI 1.193 to 2.181; p = 0.002). Supplementary analyses examining geographic distance between donor and recipient identified no association between geographic distance and recipient mortality hazard. CONCLUSIONS: An ischemic time of 4 to 6 hours was associated with optimal long-term survival in first-time pediatric LTx recipients, whereas a very short ischemic time of <4 hours and a prolonged ischemic time >6 hours were both associated with higher mortality hazard in this population.
Authors: Don Hayes; Michael O Harhay; Wida S Cherikh; Daniel C Chambers; Kiran K Khush; Eileen Hsich; Luciano Potena; Aparna Sadavarte; Tajinder P Singh; Andreas Zuckermann; Josef Stehlik Journal: J Heart Lung Transplant Date: 2020-07-23 Impact factor: 10.247