Can All Pediatric Heart Transplant Preservation Solutions Be Considered Equal?
Sarin Nitin Paluri, BS1, Zachary Brennan, DO2, Narutoshi Hibino, MD/PhD3.
1Midwestern University - Chicago College of Osteopathic Medicine, Chicago, IL, USA, 2Cedars-Sinai - Department of Cardiothoracic Surgery, Los Angeles, CA, USA, 3University of Chicago Pritzker School of Medicine - Department of Cardiac Surgery, Chicago, IL, USA.
Objective(s): There remains ambiguity as to the influence of pediatric orthotopic heart transplant (POHT) preservation solutions used during transport on the post-operative outcomes of the recipients. Recent data only shows survival analysis between the solutions but does not elucidate adverse post-operative events. We hypothesize that if donor hearts were preserved entirely in University of Wisconsin (UW) solution instead of Celsior (CS) or Custodial (HTK), then recipients will experience less post-operative adverse events and improved outcomes.
Methods: POHT recipients from 3/30/2016 to 3/6/2023 were identified using the UNOS database. Only cases with 1-yr follow up and the three most used solutions were included. Primary endpoint is 1-yr survival. Secondary endpoints are length of stay, ischemic time, acute rejection episodes (ARE), treatment for ARE within 1-yr, inotrope use, vent. support, stroke, dialysis, permanent pacemaker use, and use of ECMO and IABP at transplant.
Results: 1501 pediatric heart transplants were identified (UW, 54%; HTK, 29%; CS, 16%). Analysis of Cox regression models for survival revealed no significant differences between all solutions (p=0.163). Fisher's Exact Test showed significant differences in treatment for ARE within 1-yr (UW, 12.5%; CS, 13.4%; HTK, 17.6%; p=0.005), inotrope use (UW, 42.4%; CS, 39.8%; HTK, 48.6%; p=0.041), and ventilation support (UW, 36.3%; CS, 37.8%; HTK, 37.1%; p=0.018). All other outcomes were insignificant (p>0.05).
Comparison of three most used preservation solutions reveals UW has the least treatment for ARE within 1-yr of transplant and need for ventilation support at transplant. In addition, HTK shows the highest inotrope use during transplant.
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