Alia Dani1, Quyen Vu1, Karthik Thangappan1, Bin Huang2, Samuel Wittekind3, Angela Lorts3, Clifford Chin3, David L S Morales1, Farhan Zafar1. 1. Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 2. Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 3. Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Abstract
BACKGROUND: Studies have shown that the optimal ischemia time (IT) threshold in pediatric heart transplantation (PHT) is up to 4 h, independent of other donor organ factors. The purpose of this study was to examine the relationship between IT and donor left ventricular ejection fraction (LVEF) and study their impact on PHT outcomes. METHODS: This is a retrospective cohort study of PHT (<18 years) identified in UNOS between January 2000 and March 2020. Post-transplantation survival analysis of patients receiving donor hearts with IT<4, 4-6, and >6 h was performed using Kaplan-Meier curves. Cohort was divided according to donor LVEF median value, and survival was analyzed. Cox regression was performed. RESULTS: Median LVEF was 65% in the study cohort (6669 PHT). Overall, IT>6 h was associated with worse survival compared to <4 h regardless of donor LVEF. For allografts with LVEF < 65%, IT = 4-6 h was associated with worse survival compared with IT < 4 h (p = .006) but had similar survival compared with IT > 6 h (p = .315). For allografts with LVEF ≥ 65%, IT = 4-6 h had similar survival compared with <4 h (p = .175) but improved survival compared with >6 h (p = .003). After adjusting for donor and recipient variables, Cox regression showed that IT = 4-6 h was not associated with increased mortality for LVEF ≥ 65%. CONCLUSIONS: The IT threshold of 4 h does not apply to all allografts. Recipients of hearts with LVEF≥65% can tolerate an IT up to 6 h without any detriment to survival. Routine acceptance of these donor hearts could mitigate longer waiting times and poor donor availability for many candidates.
BACKGROUND: Studies have shown that the optimal ischemia time (IT) threshold in pediatric heart transplantation (PHT) is up to 4 h, independent of other donor organ factors. The purpose of this study was to examine the relationship between IT and donor left ventricular ejection fraction (LVEF) and study their impact on PHT outcomes. METHODS: This is a retrospective cohort study of PHT (<18 years) identified in UNOS between January 2000 and March 2020. Post-transplantation survival analysis of patients receiving donor hearts with IT<4, 4-6, and >6 h was performed using Kaplan-Meier curves. Cohort was divided according to donor LVEF median value, and survival was analyzed. Cox regression was performed. RESULTS: Median LVEF was 65% in the study cohort (6669 PHT). Overall, IT>6 h was associated with worse survival compared to <4 h regardless of donor LVEF. For allografts with LVEF < 65%, IT = 4-6 h was associated with worse survival compared with IT < 4 h (p = .006) but had similar survival compared with IT > 6 h (p = .315). For allografts with LVEF ≥ 65%, IT = 4-6 h had similar survival compared with <4 h (p = .175) but improved survival compared with >6 h (p = .003). After adjusting for donor and recipient variables, Cox regression showed that IT = 4-6 h was not associated with increased mortality for LVEF ≥ 65%. CONCLUSIONS: The IT threshold of 4 h does not apply to all allografts. Recipients of hearts with LVEF≥65% can tolerate an IT up to 6 h without any detriment to survival. Routine acceptance of these donor hearts could mitigate longer waiting times and poor donor availability for many candidates.
Authors: Allison B Davila; Wendy Shih; Liset N Stoletniy; Tim P Martens; Leonard L Bailey; Anees J Razzouk; David G Rabkin Journal: J Heart Lung Transplant Date: 2019-12-05 Impact factor: 10.247
Authors: Joseph W Rossano; Wida S Cherikh; Daniel C Chambers; Samuel Goldfarb; Kiran Khush; Anna Y Kucheryavaya; Bronwyn J Levvey; Lars H Lund; Bruno Meiser; Roger D Yusen; Josef Stehlik Journal: J Heart Lung Transplant Date: 2017-07-20 Impact factor: 10.247
Authors: Mackenzie A Ford; Christopher S Almond; Kimberlee Gauvreau; Gary Piercey; Elizabeth D Blume; Leslie B Smoot; Francis Fynn-Thompson; Tajinder P Singh Journal: J Heart Lung Transplant Date: 2011-06-14 Impact factor: 10.247
Authors: Lars H Lund; Leah B Edwards; Anna Y Kucheryavaya; Christian Benden; Jason D Christie; Anne I Dipchand; Fabienne Dobbels; Samuel B Goldfarb; Bronwyn J Levvey; Bruno Meiser; Roger D Yusen; Josef Stehlik Journal: J Heart Lung Transplant Date: 2014-08-14 Impact factor: 10.247
Authors: Jeffrey A Morgan; Ranjit John; Yookyung Park; Linda J Addonizio; Mehmet C Oz; Niloo M Edwards; Jan M Quaegebeur; Ralph S Mosca Journal: J Heart Lung Transplant Date: 2005-01 Impact factor: 10.247
Authors: Justin Godown; Richard Kirk; Anna Joong; Ashwin K Lal; Michael McCulloch; David M Peng; Janet Scheel; Ryan R Davies; Anne I Dipchand; Oliver Miera; Jeffrey G Gossett Journal: Pediatr Transplant Date: 2019-05-13
Authors: Joseph W Rossano; Tajinder P Singh; Wida S Cherikh; Daniel C Chambers; Michael O Harhay; Don Hayes; Eileen Hsich; Kiran K Khush; Bruno Meiser; Luciano Potena; Alice E Toll; Aparna Sadavarte; Andreas Zuckermann; Josef Stehlik Journal: J Heart Lung Transplant Date: 2019-08-10 Impact factor: 10.247
Authors: Tajinder P Singh; Eileen Hsich; Wida S Cherikh; Daniel C Chambers; Michael O Harhay; Don Hayes; Kiran K Khush; Luciano Potena; Aparna Sadavarte; Andreas Zuckermann; Josef Stehlik Journal: J Heart Lung Transplant Date: 2020-07-24 Impact factor: 10.247