METHODS: Patients <18 years old in the Pediatric Heart Transplant Society database were included (N=6,765) and stratified by diagnosis and era (1993-2004, 2005-2009, and 2010-2019). Severe graft failure (SGF) was defined as death, retransplant, or need for mechanical circulatory support in the first 7 days post-transplant. Descriptive statistical methods were used to compare differences between patient characteristics and IT. Kaplan-Meier survival analysis compared freedom from graft loss, rejection, and infection. Multivariable analysis was performed for graft loss and SGF (hazard and logistic regression modeling, respectively).
RESULTS: Diagnoses were cardiomyopathy (N = 3,246) and congenital heart disease (CHD; N = 3,305). CHD were younger, more likely to have an IT ≥4.5 hours, and more likely to require extracorporeal membrane oxygenation or mechanical ventilation at transplant (all p < 0.001). Median IT was 3.6 hours (interquartile range 2.98-4.31; range 0-10.5). IT was associated with early graft loss (HR 1.012, 95% CI 1.005-1.019), but not when analyzed only in the most recent era. IT was associated with SGF (OR 1.016 95%CI 1.003-1.030).
CONCLUSIONS: Donor IT was independently associated with an increased risk of graft loss, albeit with a small effect relative to other risk factors. Graft survival with prolonged IT has improved in the most recent era but the risk of SGF persists.
方法:纳入儿科心脏移植学会数据库(1993-2019)中<18岁的患者(N=6765),并按诊断和时代(1993-2004,2005-2009和2010-2019)进行分层。严重移植物衰竭(SGF)定义为死亡,重新移植,或在移植后的前7天需要机械循环支持。描述性统计方法用于比较患者特征和IT之间的差异。Kaplan-Meier生存分析比较了移植物丢失的自由,拒绝,和感染。对移植物丢失和SGF进行了多变量分析(危险和逻辑回归模型,分别)。
结果:诊断为心肌病(N=3246)和先天性心脏病(CHD;N=3305)。冠心病更年轻,更有可能有一个IT>4.5小时,移植时更可能需要体外膜氧合或机械通气(P均<0.001)。中位IT为3.6小时[IQR2.98至4.31;范围0-10.5]。IT与早期移植物丢失有关(HR1.012,95%CI1.005-1.019),但不是在最近的时代分析。IT与SGF相关(OR1.01695CI1.003-1.030)。
结论:供体IT与移植物丢失的风险增加独立相关,尽管相对于其他风险因素影响较小。在最近的时代,延长IT的移植物存活有所改善,但SGF的风险仍然存在。