Impact of occurrence of cardiac arrest in the donor on outcomes of pediatric heart transplantation
Sandeep Sainathan2, *Sameh M. Said3, Raghav Murthy4, Tamy Sujimoto1, Feng-Chang Lin1, *John Karamichalis5, Leonardo Mulinari2, Mahesh Sharma1
1Cardiothoracic surgery, The University of North Carolina at Chapel Hill, Capel Hill, North Carolina, United States, 2Cardiothoracic surgery, University of Miami, Miami, Florida, United States, 3Cardiothoracic surgery, University of Minnesota, Minneapolis, Minnesota, United States, 4Cardiothoracic surgery, Mount Sinai School of Medicine, New York, New York, United States, 5Cardiothoracic surgery, Columbia University, New York, New York, United States
Objective: Impact of cardiac arrest in the donor on outcomes of pediatric heart transplantation has not been studied
Methods: The UNOS database was queried for primary pediatric heart transplantation (1987-2021). The cohort was divided into recipients who received a cardiac allograft from a donor who sustained a cardiac arrest (CAD) leading to brain death versus a donor who did not sustain a cardiac arrest (NCAD). Recipient and donor demographics were extracted and transplant outcomes such as survival were studied. Standard statistical tests were used. Univariable and multivariable analysis was done, and survival analysis was done using the Kaplan-Meir method. A p-value < 0.05 was considered significant.
Results: 7300 patients underwent primary pediatric transplant during the period of which 579 (7.9%) patients belonged to the CAD group. The CAD group patients were younger (Median age 3 vs. 5 years, p< 0.001), of the male gender, smaller in weight, height, and BMI as compared to the NCAD group. There was no difference in the primary cardiac heart failure diagnosis and blood type in the groups. The donors in the CAD group were as expected younger (median 3 vs 6 years, p<0.001) and the mechanism of death was more likely to be due to drowning and asphyxiation than the blunt injury and intracranial hemorrhage seen in the NCAD group. Also, the donors in the NCAD group were likely to be on vasopressin, diuretics, and antihypertensives but the EF was similar between the groups. When VAD and ECMO use prior to transplant was compared, there were no differences. The listing status, days on the waitlist, ischemic times were similar between the groups. Immediate post-transplant outcomes such as 30-day mortality, treated rejection at 1-year, dialysis, pacemaker use, stroke were no difference between the groups. Similarly, the 1-year and 3-year mortality were similar between the groups. Long-term survival was similar between the groups. Multivariable analysis showed donor cardiac arrest was not an independent predictor of mortality.
Conclusion: Occurrence of donor cardiac arrest has no impact on overall recipient survival and immediate transplant post-operative outcomes in pediatric heart transplant recipients.
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