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

Objective: comparative analysis of long-term outcomes following heart transplantation (HT) with prolonged and short cold ischemia.

Materials and methods. We analyzed the data of 29 orthotopic HT with >4 hours of cold ischemia. The transplant surgery was performed at Meshalkin National Medical Research Center between 2013 and the present time. Organs were obtained from donors from other regions. The control group consisted of 29 HTs with cold ischemia <4 hours, performed in the same period. The minimum distance between the transplant center and the donor base was about 250 km (Barnaul); the maximum distance was about 850 km (Krasnoyarsk). Recipient survival and postoperative peculiarities were analyzed.

Results. In-hospital survival in the prolonged cold ischemia group was 89.7% (n = 26) with 3 deaths (10.3%). In the second group (<240 min), in-hospital survival was 79.3% (n = 23) with 6 (20.7%) deaths. The Kaplan-Meier survival analysis showed no difference between the groups (Log-Rank Test, P 1/4 0.59). In addition, cold ischemia time did not increase the risk of graft rejection and the risk of transplant coronary artery disease (TCAD).

Conclusion. HT with cold ischemia >4 hours did not have worse outcomes than in short graft ischemia. This provides grounds for further accumulation of experience in the use of heart donors from remote locations.

1. Shafiq F, Wang Y, Li G et al. Clinical outcome of donor heart with prolonged cold ischemic time: A single-center study. JCardSurg. 2019; 35 (2): 397-404. doi: 10.1111/jocs.14404.

2. Gautier SV Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2020 13th Report from the Registry of the Russian Transplant Society. Russian Journal of Transplantology and Artificial Organs. 2021; 23 (3): 8-34. https://doi.org/10.15825/1995-1191-2021-3-8-34.

3. Nicholas R, Thomas Helen L et al. The importance of cold and warm cardiac ischemia for survival after heart transplantation. Original articles. Clinical transplantation. 2008 Aug 27; 86 (Issue 4): 542-547. doi: 10.1097/TP.0b013e31818149b9.

4. Трансплантация сердца. Национальные клинические рекомендации. 2013. Heart transplantation. National clinical guidelines. 2013.

5. Valero-Masa MJ, Gonzalez-Vdchez F, Almenar-Bonet L et al. Cold ischemia >4 hours increases heart transplantation mortality. An analysis of the Spanish heart transplantation registry. Int J Cardiol. 2020; 319: 14-19.

6. Nicoara A, Ruffin D et al. Primary graft dysfunction after heart transplantation: Incidence, trends, and associated risks. American Journal of Transplantation. 2018; 18 (Issue 6): 1461-1470. https://doi.org/10.1111/ajt.14588.

7. Tang P Lei L et al. Risk factors for heart transplantation survival with greater than 5 h of donor heart ischemic time. Journal of Cardiac Surgery. 2021 Aug; 36 (8): 2677-2684. doi: 10.1111/jocs.15621.

8. Tenchurina EA, Minina MG. Modern ideas in heart donor selection criteria. Russian Journal of Transplantology and Artificial Organs. 2020; 22 (3): 174-181. https://doi.org/10.15825/1995-1191-2020-3-174-181.

9. Yeen W, Polgar A, Guglin M et al. Outcomes of adult orthotopic heart transplantation with extended allograft ischemic time. Transplant Proc. 2013; 45 (6): 23992405.

10. Gaffey AC, Chen CW, Chung JJ et al. Extended distance cardiac allograft can successfully be utilized without impacting long-term survival. J Heart Lung Transplant. 2017; 36 (9): 968-972. doi: 10.1016/j.hea-lun.2017.04.002.