The Importance of Cold and Warm Cardiac Ischemia for Survival After Heart Transplantation

Banner, Nicholas R.; Thomas, Helen; Curnow, Elinor; Hussey, J.C.; Rogers, Chris; Bonser, Robert S.

doi:10.1097/tp.0b013e31818149b9

Cited by 128 publications

(80 citation statements)

References 12 publications

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“…The literature (see, e.g., [31] and references therein) reports on a direct negative influence of the duration the organ is outside the donor's body on the chances of a successful transplantation. Banner et al [4] report on a decrease in the recipient survival rates within 30 days of heart transplantation in the case of longer ischemia times (including transport times and surgical implant times). Hence, organ transport distances are critical to outcome in liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Optimizing the facility location design of organ transplant centers

Beliën¹,

Boeck²,

Colpaert³

et al. 2013

Decision Support Systems

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a b s t r a c t a r t i c l e i n f o Available online xxxx Keywords:Facility location Organ transplant Long-term planning Mixed integer linear programming This paper presents a mixed integer linear programming (MILP) long-term decision model to optimize the location of organ transplant centers. The objective is to minimize the sum of the weighted time components between the moment a donor organ becomes available and its transplantation into the recipient's body. The weight factor for the elapsed time before the organ's removal from the donor body allows to assign a lower weight to this time component in the objective function in order to reflect the criticality of the process after the organ's removal. The specificity of organ transplants makes the model more complex than a traditional facility location model. The model is applied to the Belgian organ transplant path. Extensive numerical experiments reveal the key factors that impact the long-term decision of centralizing versus decentralizing transplant centers.

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Section: Introductionmentioning

confidence: 99%

Optimizing the facility location design of organ transplant centers

Beliën¹,

Boeck²,

Colpaert³

et al. 2013

Decision Support Systems

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“…Prolonged ischemia time has been demonstrated to be one of the most important risk factors of early graft dysfunction of the implanted heart and therefore primary graft failure, the most frequent cause of death within the first month after heart transplantation. Every increase in this time means a higher possibility of developing early graft failure; however, as shown in both the ISHLT registry 2012, heart statics (6) and in the paper by Banner et al (7), there is a significant and incremental increase of the risk of primary graft failure after 180 minutes of cold ischemic time. This has resulted in enormous organizational challenges, expedited surgery in which standard hemostasis and other steps have to be sacrificed in order to facilitate shorter ischemia times, the inability to transport organs across greater distances and the necessity to err on the side of caution if the risks of an extended ischemia seem significant, thus, effectively limiting the available donor pool even further.…”

Section: Cold Ischemic Storagementioning

confidence: 99%

Current approaches in retrieval and heart preservation

Vela

Sáez

Simon

2018

Ann. Cardiothorac. Surg.

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Fifty years after the first successful heart transplantation, despite multiple advances in the treatment of advanced acute and chronic heart failure, there is still no equivalent to heart transplantation as a long-term treatment for end-stage heart failure. Transplantation is, however, limited by the scarcity and quality of heart allografts. Donors are nowadays significantly older, particularly in European countries, and traumatic head injury as the cause of death has been replaced by intracerebral hemorrhage or hypoxic brain damage in the majority of cases. In addition, many donors have undergone extensive resuscitation efforts. Recipient characteristics have progressively changed too within the last couple of decades; recipients are older, often with comorbidities and nearly half of them are bridged to transplant with a wide variety of mechanical circulatory support devices. These developments have resulted in heart transplant surgery becoming significantly more challenging with longer more complex surgery and increased ischemia times for organs that were previously considered to be borderline or non-transplantable in many cases. To address this, several options have been explored within the last years and as a result, novel strategies have been developed and tested in order to optimize graft preservation and potentially increase the donor pool. The two notable developments are the ability to procure hearts from donors after circulatory death and the advent of ex-vivo perfusion of hearts. This technology has made the transplantation of extended criteria organs, including those from circulatory determined death (DCD) donors possible, and allow for out of body time of more than 12 hours in heart transplantation. In this review, we set out the basis of the current practices in organ procurement, and the opportunities for the future as demands for organ transplantation continue to increase.

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“…This has not only resulted in scientific output, but has also likely lowered the threshold for patients to contact the transplant nurses and physicians in case of questions or problems. It may have also assisted in creating a culture where patients and their families form a team together with Primary graft failure [16] Acute rejection [7] Late graft failure (HFrEF) [6] [Non] STEMI [4] Post-PCI/CABG [3] Technical problems during HTx [3] Stroke/intracranial bleeding [12] Aortic rupture [4] Intestinal ischemia [3] Malignancy 78 [32] Lung [35] GI tract [10] PTLD [9] Kidney-bladder [6] Pancreas [4] Blood [4] Prostate [3] Skin [3] Primary tumor unknown [3] Brain [1] Infection 43 [18] Pneumonia [22] Sepsis [15] Other [6] Other 27 [11] Old age [8] Dementia [5] Suicide [4] Therapy withdrawal [3] Trauma [3] Respiratory failure [1] Bleeding [1] ALS [1] Euthanasia [1] Finally, we pay a lot of attention to cardiovascular prevention and screening for malignancies. The significant and consistent decreases in age-adjusted cardiovascular mortality shown in European and US registries was attributed to better prevention and better treatment of cardiac disease (29).…”

Section: Discussionmentioning

confidence: 99%

“…All rights reserved. Ann Cardiothorac Surg 2018;7(1):106-117 www.annalscts.com of the donor heart is performed by our own surgeons, the direct communication between the procurement and the implanting team might help to significantly reduce ischemic times (15)(16)(17)(18). Also, most donors come from Belgian hospitals which results in short transportation times.…”

Section: Discussionmentioning

confidence: 99%

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How to obtain and maintain favorable results after heart transplantation: keys to success?

Cleemput

Verbelen²,

Aelst

et al. 2018

Ann. Cardiothorac. Surg.

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We compared survival in our heart recipients with survival rates reported by the International Society of Heart and Lung Transplantation (ISHLT) Registry. As recipient and donor characteristics are changing over time, we studied four different eras. In order to differentiate between short-and long-term survival, we analyzed both overall survival and survival at one year. Obviously, this exercise is only relevant when baseline donor and recipient characteristics are comparable, as these differences may affect the outcome in opposite directions. To overcome this potential bias as much as possible, we calculated the Index for Mortality Prediction After Cardiac Transplantation (IMPACT)-scores and the Donor Risk Index (DRI). Looking to our results, we found that our DRIs in the different eras are almost equal to those obtained from the United Network for Organ Sharing database in the very same eras. Our IMPACT-scores, on the other hand, seem higher than those reported by ISHLT. Survival after transplantation and conditional on 1-year survival was higher than the outcome reported by the ISHLT Registry. As our operation technique and post-transplant immunosuppressive schedule did not differ from most centers, we speculated on potential factors that might contribute to our positive results. Patient selection and a relatively short waiting time are important contributors to the overall survival benefit. Our centralized follow-up may also have played an important role. Finally, the indefinite compulsory health insurance coverage in our country and easy access to different screening programs might also have influenced our outcome in a positive way. We are well aware that with challenges like donor organ shortage, more and more patients on mechanical circulatory support (MCS) will affect outcomes in the future.Keywords: Heart transplantation; predictors; survival Submitted Sep 11, 2017. Accepted for publication Nov 25, 2017Nov 25, . doi: 10.21037/acs.2017 View this article at: http://dx.doi.org/10. 21037/acs.2017.12.03 Perspective IntroductionComparing the results of hip surgery performed by one surgeon with the results of his colleague working in the hospital next door, is asking for trouble. Comparing results of one heart transplant center with those of another or, even more challenging, those of a registry, is at least as daunting.Nevertheless, it is worthwhile to critically review one's results and compare them with those of peers. In case they differ manifestly, one has to speculate on why this is the case considering the importance our society currently attributes to cost effectiveness and transparency. Of course, this exercise only makes sense when you are comparing apples with apples. You should first examine that you are transplanting the same types of patients and that you are using the same types of donors.We compared our short-and long-term survival data with those of the ISHLT registry. To do so, we also compared our recipient and donor risk profiles with those of the UNOS database. Finally, we speculated...

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The Importance of Cold and Warm Cardiac Ischemia for Survival After Heart Transplantation

Abstract: Both transport and implant times were directly related to 30-day mortality after heart transplantation. Ischemia time should be considered in organ allocation and controlled during the heart transplant procedure.

Cited by 128 publications

References 12 publications

Optimizing the facility location design of organ transplant centers

Optimizing the facility location design of organ transplant centers

Current approaches in retrieval and heart preservation

How to obtain and maintain favorable results after heart transplantation: keys to success?

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