Abstract：
BACKGROUND: Impacts of ischemic time (IT) on pediatric heart transplant outcomes are multifactorial. We aimed to analyze the effect of prolonged IT on graft loss after pediatric heart transplantation. We hypothesized that graft survival with prolonged IT has improved across eras.
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.
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.
摘要：
背景：缺血时间（IT）对小儿心脏移植结果的影响是多因素的。我们旨在分析延长IT对小儿心脏移植后移植物丢失的影响。我们假设长期IT的移植物存活率在不同时期有所改善。
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。
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。
