T. B. Shaw1, S. Littre2, K. Carter1, H. Cockrell1, M. Kutcher4, M. S. Ghanamah3, B. Kogon3, H. Copeland5 1University Of Mississippi,General Surgery,Jackson, MS, USA 2University Of Mississippi,Data Science,Jackson, MS, USA 3University Of Mississippi,Pediatric Cardiac Surgery,Jackson, MS, USA 4University Of Mississippi,Trauma Surgery/Critical Care,Jackson, MS, USA 5University Of Mississippi,Adult Cardiac Surgery,Jackson, MS, USA
Introduction:
Few studies exist directly comparing outcomes between the most commonly used preservation solutions in a large cohort of pediatric heart transplant recipients. The purpose of this study is to investigate the effect of the cardiac preservation solution on survival in pediatric heart transplant recipients.
Methods:
The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from 01/2004-03/2018 for pediatric donor hearts. After exclusions for multi-organ transplants (tx), age (donor > 20 years(y), recipient > 18y), ejection fraction (EF) (<10% or > 85%), donors with no preservation data and those were no solution was used, 3,012 donor hearts were included for analysis. The preservation solutions included: saline, University of Wisconsin (UW), “cardioplegia”, Celsior, and Custodiol. Solutions were compared to saline. The primary endpoints were recipient survival at 30 days, 1 year, and long-term. Logistic and Cox models were used to quantify survival endpoints.
Results:
After exclusion criteria, 3,012 recipients had preservation solution data available. Saline the preservation solution in 408 patients (14%), UW 1,203 (40%), cardioplegia 461 (15%), Celsior 542 (18%), and Custodiol 398 (13%). Donor age ranged from 0–18y (mean=6.6, median=4), 60% were male and <1% were diabetic. Donor EF ranged from 28%-85% (mean=63.8%, median=65%), ischemic time from 0.18-11.5 hours (mean=3.66, median=3.62), and distance to recipient hospital from 0-2523 miles (mean 361, median 312). Survival of recipients whose donor hearts were procured with saline was 96%-30 day, 90%- 1 year, UW: 97%-30 day, 92%-1year, cardioplegia: 97%-30 day, 91%-1 year, Celsior: 97%-30 day, 93%- 1 year, and Custodial: 97%-30 day and 91%- 1 year (Figure 1A). This differences were not statistically supported in adjusted models (all p>0.136). Analysis of Cox models for long-term survival revealed no statistical differences when comparing saline to UW (p=0.996), cardioplegia (p=0.872), Celsior (p=0.202), or Custodial (p=0.522) in adjusted models (Figure 1B).
Conclusion:
Although there may be some short-term survival benefits to using the above preservation solutions vs. saline in pediatric heart transplantation, the differences were not statistically significant. This contrasts to a similar analysis in adults where UW and Custodial were shown to have some short-term benefits (higher 1-year survival) while cardioplegia was found to have lower 30 day, 1 year, and overall survival than saline. The type of preservation solution used for donor hearts has no impact on overall survival in pediatric heart transplant recipients.
