Impact of Donors on Vasoactive Medications on Clinical Outcomes in Pediatric Heart Transplantation
David Blitzer1, Seth Lirette2, *Jack Copeland3, David Baran4, *Hannah Copeland5
1Columbia University, New York, New York, United States, 2Fulcrum, Jackson, Mississippi, United States, 3University of Ariznoa, Tucson, Arizona, United States, 4Sentara Heart Hospital, Norfolk, Virginia, United States, 5Indiana University, Fort Wayne, Indiana, United States
Objectives: There is limited data examining the effect of donor vasopressor or inotrope medications on outcomes in pediatric orthotopic heart transplant (OHT). The purpose of this study was to evaluate the effects of the most commonly used vasoactive pressors and/or inotropes on pediatric OHT outcomes.
Methods: The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from January 2000-March 2018 for donor hearts. Exclusion criteria included multiorgan transplants and recipient age > 18. Donors on vasoactives at the time of procurement were compared to donors without, including the number of vasoactives and the type (ie dopamine, dobutamine, norepinephrine and epinephrine). The primary endpoint was survival at 30 days, one year survival and post-transplant rejection. Logistic and Cox models were used to quantify survival endpoints.
Of 6,462 included donors, 3,187 (49.3%) had at least one vasoactive. Mean donor age was 5.68±5.89, with 60% male (n=3878). Mean donor EF was 63.99±8.60. Comparing donors on any vasoactive medication vs none, there was no difference in 30 day survival (OR=0.86), 1 year survival (OR=0.81), overall survival (HR=0.87) or post-transplant rejection (HR=0.90). Similarly, there was no difference for patients on 2+ vasoactives in 30 day survival (OR=0.59), 1 year survival (OR=0.64), overall survival (HR=0.81) or post-transplant rejection (HR=0.86)(Figure 1). In a comparison of the vasoactive types, vasopressin was associated with decreased 30 day mortality (OR=0.06; p=0.028), dobutamine with decreased 1 year mortality (OR=0.15; p=0.036), overall survival (HR=0.33; p=0.003) and post-transplant rejection (HR=0.44; p=0.012).
There is no difference in pediatric OHT outcomes when the donor patient is on vasoactives at the time of procurement. Specific vasoactive types may yield different clinical outcomes. This information can be used to better guide the medical management of donors leading into procurement to better optimize recipient outcomes.
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