Posttransplant outcomes with prolonged donor heart ischemic time in the pediatric population.

Avoiding grafts with ischemic time (IT) >6 hours continues to be advised in pediatric heart transplant (HTx). We sought to evaluate the association between IT and clinical outcomes in a geographically remote center. This was a retrospective single-center analysis of patients transplanted between January 1995 and December 2020. Baseline characteristics and post-HTx outcomes were compared across 3 IT groups (<4.5 hours, 4.5-6 hours, and >6 hours) with results reported in that order. Cox proportional hazard modeling was used to determine factors associated with graft failure. Of the 188 patients, 56.4% were men, the median age was 3.0 years (interquartile range, 0.6, 10.2 years), and 46.3% had congenital heart disease. IT was evenly distributed among the cohort (37.2% vs 31.4% vs 31.4%). There were no differences in early post-HTx morbidity, including primary graft dysfunction (2.9% vs 1.7% vs 5.3%, P = .5). Compared with IT <4.5 hours, longer IT was not associated with graft failure (IT 4.5-6 hours: hazard ratio, 1.10 [0.50-2.39]; P = .810 and [IT >6 hours: hazard ratio 1.10 {0.52-2.35}]; P = .797). In our population, IT was not an independent risk factor for post-HTx morbidity or graft failure. Use of a modified del Nido preservation solution and experience with prolonged IT donors may have contributed to our outcomes.