Outcome of hearts with cold ischemic time greater than 300 minutes. A case-matched study

• Published in: European journal of cardio-thoracic surgery 2005-07, Vol.28 (1), p.143-148
• Main Authors: Mitropoulos, Fotios A., Odim, Jonah, Marelli, Daniel, Karandikar, Kalyani, Gjertson, David, Ardehali, Abbas, Kobashigawa, Jon, Laks, Hillel
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Cardiac allograft; Cardiology. Vascular system; Case-Control Studies; Cause of Death; Cold Temperature; Graft Rejection; Heart Failure - surgery; Heart Transplantation; Humans; Immunosuppression - methods; Medical sciences; Middle Aged; Organ Preservation - methods; Orthotopic heart transplantation; Pneumology; Prolong ischemia time; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Time Factors; Tissue Donors; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2005.01.067

Objective: Expansion of potential donor pool may be facilitated by using cardiac allografts with long ischemic time. Early graft failure and potential relation to transplant coronary artery disease remains a concern. We sought to evaluate outcomes of heart transplantation in recipients of donor allografts with prolonged ischemia time. Methods: The study group consisted of 46 (mean age, 52 years) consecutive patients at UCLA from 1994 to 2002 that underwent heart transplantation with ischemia time ≫300min. This group was compared to a case-matched control group of 46 (mean age, 51 years) patients identified from our database during this time frame for the following factors: UNOS status, congenital heart disease diagnosis, preop inotropes, pretransplantation creatinine≫1.5 and recipient age. Primary endpoint was mortality and secondary were rejection rate and transplant coronary artery disease. Allografts were perfused and stored in cold University of Wisconsin solution. Results: Mean donor ages of the study and case-matched control group were 34±15 and 34±14 years, respectively. Mean ischemia times were 388 (range, 301–600min) and 173 (range, 96–236min), respectively. The death incidence rate per 100 transplants per year was 9% for the study group and 7.4% for the matched group (P=0.50). Thirty-day mortality for the study and case-matched groups were 4.3 and 2.1%, respectively (P=0.9). Late mortality was 16.5 and 18.5%, respectively (P=0.9). The risk of death after 30 days was 7.5 and 5.8%, respectively (P=0.5, log-rank). One-year incidence of acute cellular rejection in the study and case-matched groups were 2 and 4.5% (P=0.36), respectively. One-year incidence of transplant coronary artery disease in the study and case-matched groups were 4.3 and 5.4%, respectively (P=0.68). Conclusions: Donor hearts with ischemia time greater than 300min provide comparable early and intermediate outcomes given judicious and careful donor and recipient matching and our current techniques of myocardial preservation and modified reperfusion.