{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T13:28:04Z","timestamp":1770816484430,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T00:00:00Z","timestamp":1646697600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL147957"],"award-info":[{"award-number":["R01HL147957"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Studies have shown that the optimal ischemia time (IT) threshold in pediatric heart transplantation (PHT) is up to 4\u00a0h, independent of other donor organ factors. The purpose of this study was to examine the relationship between IT and donor left ventricular ejection fraction (LVEF) and study their impact on PHT outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective cohort study of PHT (&lt;18\u00a0years) identified in UNOS between January 2000 and March 2020. Post\u2010transplantation survival analysis of patients receiving donor hearts with IT&lt;4, 4\u20136, and &gt;6\u00a0h was performed using Kaplan\u2013Meier curves. Cohort was divided according to donor LVEF median value, and survival was analyzed. Cox regression was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median LVEF was 65% in the study cohort (6669 PHT). Overall, IT&gt;6\u00a0h was associated with worse survival compared to &lt;4\u00a0h regardless of donor LVEF. For allografts with LVEF\u00a0&lt;\u00a065%, IT\u00a0=\u00a04\u20136\u00a0h was associated with worse survival compared with IT\u00a0&lt;\u00a04\u00a0h (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.006) but had similar survival compared with IT\u00a0&gt;\u00a06\u00a0h (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.315). For allografts with LVEF\u00a0\u2265\u00a065%, IT\u00a0=\u00a04\u20136\u00a0h had similar survival compared with &lt;4\u00a0h (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.175) but improved survival compared with &gt;6\u00a0h (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.003). After adjusting for donor and recipient variables, Cox regression showed that IT\u00a0=\u00a04\u20136\u00a0h was not associated with increased mortality for LVEF\u00a0\u2265\u00a065%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The IT threshold of 4\u00a0h does not apply to all allografts. Recipients of hearts with LVEF\u226565% can tolerate an IT up to 6\u00a0h without any detriment to survival. Routine acceptance of these donor hearts could mitigate longer waiting times and poor donor availability for many candidates.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14259","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T10:17:33Z","timestamp":1646734653000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effect of ischemic time on pediatric heart transplantation outcomes: is it the same for all allografts?"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2493-1603","authenticated-orcid":false,"given":"Alia","family":"Dani","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery Cincinnati Children's Hospital Medical Center  Cincinnati Ohio 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USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3192-0646","authenticated-orcid":false,"given":"Samuel","family":"Wittekind","sequence":"additional","affiliation":[{"name":"Division of Cardiology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1447-5456","authenticated-orcid":false,"given":"Angela","family":"Lorts","sequence":"additional","affiliation":[{"name":"Division of Cardiology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5168-456X","authenticated-orcid":false,"given":"Clifford","family":"Chin","sequence":"additional","affiliation":[{"name":"Division of Cardiology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7512-1777","authenticated-orcid":false,"given":"David L.S.","family":"Morales","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1803-7242","authenticated-orcid":false,"given":"Farhan","family":"Zafar","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Cincinnati Children's Hospital Medical Center  Cincinnati Ohio 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of graft cold ischemia does not affect outcomes in pediatric heart transplant recipients","volume":"106","author":"Scheule AM","year":"2002","journal-title":"Circulation"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2003.10.017"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13912"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/circ.142.suppl_3.15874"},{"key":"e_1_2_11_16_1","unstructured":"Eliminate the use of DSAs in thoracic distribution \u2010 OPTN. 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