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(Circulation. 2002;106:I-163.)
© 2002 American Heart Association, Inc.

Thoracic Transplantation and Mechanical Support for Congestive Heart Failure

Duration of Graft Cold Ischemia Does Not Affect Outcomes in Pediatric Heart Transplant Recipients

Albertus M. Scheule, MD; Grenith J. Zimmerman, PhD; Joyce K. Johnston, RN; Anees J. Razzouk, MD; Steven R. Gundry, MD; Leonard L. Bailey, MD

From the Departments of Surgery and School of Allied Health Professions, Loma Linda University School of Medicine, and Children’s Hospital, Loma Linda, Calif.

Correspondence to Dr Leonard L. Bailey, Professor of Surgery, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354. E-mail lbailey{at}som.llu.edu

Abstract

Background Utilizing donor hearts with prolonged graft ischemia may extend the donor pool.

Methods and Results The medical records of 363 infants and children, aged 1 day to 17 years, transplanted at Loma Linda University between November 1985 and March 2001, were retrospectively reviewed. Fourteen children received organs with prolonged ischemic times (>8 hours)(PIT) compared with 14 with short ischemic times (90 minutes)(SIT). There were no significant differences when comparing donors for gender, age, weight, cause of death, or duration of cardiopulmonary resuscitation. Preoperative donor shortening fraction (%), as determined by echocardiography, was significantly higher in the SIT group (44.5 versus 36.5%; P=0.006). There were no significant differences between PIT and SIT recipients when comparing age at transplant, weight at transplant, waiting time, weight mismatch, postoperative days on ventilator, duration of inotropic support, and hospital stay. Cardiopulmonary bypass time was significantly longer in the PIT group (140.5 versus 80.5 minute; P=0.001). Median length of follow-up for both groups was approximately 5 years. Five grafts were lost in the PIT group; 7 were lost in the SIT group, with 1 early graft loss in each group. Significant posttransplant coronary artery disease was diagnosed in 2 recipients in each group (PIT: 80 and 42; SIT: 84 and 67 months posttransplant). There was no significant difference between groups in actuarial graft survival. Number of rejection episodes and hospital readmissions during the first posttransplantation year did not differ significantly between groups.

Conclusion Late outcomes were not adversely affected by donor hearts preserved by single dose cold crystalloid cardioplegia with greater than 8 hours of cold ischemia.

Key Words: pediatrics • transplantation • surgery • ischemia