التفاصيل البيبلوغرافية
| العنوان: |
Prolonged Warm Ischemic Time is Safe for Cardiac Donation after Circulatory Death. |
| المؤلفون: |
Pasrija, C.1 (AUTHOR), DeBose-Scarlett, A.1 (AUTHOR), Keck, C.D.1 (AUTHOR), Scholl, S.R.1 (AUTHOR), Siddiqi, H.K.1 (AUTHOR), Amancherla, K.1 (AUTHOR), Brinkley, D.M.1 (AUTHOR), Lindenfeld, J.1 (AUTHOR), Menachem, J.1 (AUTHOR), Ooi, H.1 (AUTHOR), Pedrotty, D.1 (AUTHOR), Punnoose, L.1 (AUTHOR), Rali, A.1 (AUTHOR), Sacks, S.1 (AUTHOR), Wigger, M.1 (AUTHOR), Zalawadiya, S.1 (AUTHOR), McMaster, W.1 (AUTHOR), Shah, A.S.1 (AUTHOR), Schlendorf, K.1 (AUTHOR), Trahanas, J.1 (AUTHOR) |
| المصدر: |
Journal of Heart & Lung Transplantation. 2023 Supplement, Vol. 42, pS94-S95. 2p. |
| مصطلحات موضوعية: |
*RED blood cell transfusion, *NEPHRECTOMY, *HEART transplant recipients, *HEART transplantation, *ISOLATION perfusion, *PULMONARY hypertension, *OXYGEN saturation |
| مستخلص: |
Prolonged warm ischemic time (WIT) has been considered a contraindication to cardiac transplant for donation after cardiac death (DCD). We anecdotally found excellent outcomes with DCD hearts with a prolonged WIT, prompting us to remove WIT restrictions. We hypothesized that a prolonged WIT is safe and can lead to excellent graft function. A retrospective analysis of DCD heart transplant recipients (02/2020-10/2022) was performed (N=104). Patients were stratified by WIT <25 (short WIT) or ≥25 (long WIT) minutes. WIT was defined as systolic BP<50 mmHg or SaO2 <70% to onset of reperfusion (normothermic regional perfusion (NRP)) or cross-clamp (machine perfusion (MP)). Outcomes included primary graft dysfunction (PGD), inotrope score, and 1-year survival with adjustment for reperfusion strategy (NRP or MP), pulmonary hypertension, preoperative temporary mechanical support, and intraoperative RBC transfusions. WIT data was available in 95 transplants (NRP: 71, MP: 24). Median WIT was 19 mins (IQR:17-24, Range:9-87). 20% had a long WIT (median WIT: 31 mins (IQR:28-67)). On unadjusted and adjusted analyses, WIT (as a continuous variable) was not associated with PGD (adjusted OR: 1.00 (0.98-1.01), P=0.56), 24hr inotrope score (B=-0.03 (-0.14-0.07), P=0.49), or 72hr inotrope score (B=0, (-0.1-0.1), P=0.9) (FIGURE). After stratifying into short vs long WIT, there was significantly more PGD in the long WIT group on unadjusted analysis (P=0.04). However, after adjustment, this was no longer significant (OR: 1.3 (0.75-2.31), P=0.35). Among hearts evaluated but turned down for transplant (N=9), WIT (22 (IQR:19-26) mins) was similar compared to hearts transplanted (P =0.39). 1-year survival was 92% with short WIT and 91% with long WIT (P=0.81). Prolonged WIT does not significantly impact early graft function in DCD heart transplantation. Given the opportunity to evaluate donor hearts in-situ or ex-vivo, elimination of WIT restrictions may allow for expansion of the donor pool. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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