Clinical outcome of donor heart with prolonged cold ischemic time: A single‐center study

Abstract

Objectives: Due to the shortage of donor pool, there has been a need for organs with prolonged cold ischemic time. This study aims to evaluate the short-term results of different cold ischemic times in orthotopic heart transplantation based on a singlecenter experience in China. Methods:We retrospectively analyzed outcomes of the heart transplant patients from 1 January 2015 to 31 December 2017. The recipient population was divided into four groups. Group 1: cold ischemic time greater than 8 hours; group 2: the cold ischemic time between 6 and 8 hours; group 3: the cold ischemic time between 4 and 6 hours; and group 4: cold ischemic time less than 4 hours. Efficacy indicators included after transplant survival, infection rate, rejection rate, and complications.Results: The four groups have similar donor and recipient baseline characteristics (P > .05).Cold ischemic time greater than 8 hours had more cardiopulmonary bypass (CPB) time (127.62 ± 50.23 minutes; P = .003), CPB-assist time (86.14 ± 36.74 minutes; P = .047), and higher intra-aortic balloon pump (IABP) usage rate postoperatively (47.36%; P = .010). Cold ischemic time greater than 8 hours witnessed a relatively higher mortality rate compared with the other three groups (P = .115, P = .078, and P = .114) during the 2-year follow-up.Survival rates of 1 and 2 years for the four groups were 78.95%, 87.13%, 87.32%, and 87.50% and 68.42%, 85.14%, 85.92%, and 83.93%, respectively.Conclusion: Cold ischemic time less than 8 hours can be reasonably applied to expand the heart transplantation donor pool. Cold ischemic time greater than 8 hours might result in longer CPB time, CPB-assist time, and higher IABP usage postoperatively. It might also affect the in-hospital and 2-years survival rate.

Expanding the Criteria for Heart Transplantation Donors: A Review of DCD, Increased Ischemic Times, HCV, HIV, and Extended Criteria Donors

“…Post-HT survival among recipients of allografts with longer IT has been reported to be inferior or similar to that of recipients of allografts with shorter IT, depending on the study. Multiple studies report no difference in survival by IT [63][64][65][66][67][68]. However, more recent studies report an increase in mortality after 4 hours IT [69,70], with Yeen et al [71] finding no difference in survival for less than 4 hours IT vs. 4-5 hours IT but a decrease in survival with IT greater than 5 hours.…”

Experience of heart transplantation with an extended cold ischemic time of donor heart

“…По данным многих исследований, непосредственные и отдаленные результаты ОТС с короткой и длительной ишемией донорского сердца сопоставимы [8][9][10][11], что согласуется с нашими данными. Однофакторный регрессионный анализ не выявил влияние длительности холодовой ишемии на госпитальную выживаемость.…”

“…По их мнению, донорские сердца с холодовой ишемией <8 ч могут быть безопасно использованы для увеличения донорского пула. Холодовая ишемия трансплантата >8 ч являлась предиктором более высокого уровня смертности по сравнению с другими тремя группами в течение 2-летнего периода наблюдения, а также более продолжительного искусственного кровообращения [10].…”

Mid-term and long-term outcomes following heart transplantation with prolonged cold ischemia

“…В современном мире все большее число людей нуждаются в трансплантации сердца ввиду прогрессирования и декомпенсации хронической сердечной недостаточности (ХСН) [1]. Низкий уровень органного донорства и критический дефицит донорских органов остается камнем преткновения в области трансплантации органов и тканей в России.…”