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Extended Donor Ischemic Time is Not Associated with Poor Outcome in Pediatric Heart Transplantation
Francisco Gensini, Justin Linam, Yuk Law, *Lester Permut, D. Michael McMullan, Andrea Morscheck, Robert Boucek, *Gordon Cohen
Seattle Children's, Seattle, WA
Background: The donor pools of many pediatric heart transplant centers are limited. Expanding donor criteria to include extended cardiac ischemic times (greater than 4 hours) would greatly enlarge donor pools. However, the significance of extended donor ischemic time (DIT) is not well known in pediatric heart transplantation. We examined our center’s outcomes using extended DIT as a risk factor.
Methods: All transplants from 1994 to 2008 were included in the analysis. Subjects were divided into group A, DIT ≥ 4 hours, and group B, DIT < 4 hours. We used statistical methods to evaluate DIT as both a categorical variable (≥/< 4 hours) and continuous variable vs. survival at several post-operative time points. We also analyzed DIT vs. 23 other perioperative data points to assess potential confounding variables within the groups.
Results: There were 49 transplants performed during the study period. Group A (n=31, 52% male) had a mean age of 4.7 ± 5.0 years (range: 0.0 - 14.8). Group B (n=18, 50% male) had a mean age of 8.3 ± 6.1 years (range: 0.2 - 17.6). There were 7 deaths (22.6%) in group A: 5 early (pre-discharge) and 2 late. Causes of death were renal failure (3), acute rejection (2), multiple organ system failure (1), and sepsis (1). There were 3 deaths (16.7%) in group B: 2 early and 1 late. Causes were acute rejection (2) and multiple organ system failure (1). Fisher’s exact test did not show a statistical difference in survival between the groups (p=0.572). Logistic regression failed to show extended DIT (as a continuous variable) to be a risk factor for mortality (p=0.430). DIT did not correlate with any of the other perioperative variables analyzed. Of note, patients in the extended DIT group were not more likely to require mechanical cardiopulmonary support (p=0.288) or to have poor ventricular function post-transplant (p=1.000).
Conclusions: Extended DIT was not associated with poor outcome in our study. Pediatric transplant centers with limited donor pools should consider accepting hearts with DIT > 4 hours
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