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- Title
Risk factors for heart transplant survival with greater than 5 h of donor heart ischemic time.
- Authors
Tang, Paul C.; Lei, Ienglam; Chen, Y. E.; Wang, Zhong; Ailawadi, Gorav; Romano, Matthew A.; Salvi, Shachi; Aaronson, Keith D.; Si, Ming‐Sing; Pagani, Francis D.; Haft, Jonathan W.
- Abstract
Objective: Implantation of donor hearts with prolonged ischemic times is associated with worse survival. We sought to identify risk factors that modulate the effects of prolonged preservation. Methods: Retrospective review of the United Network for Organ Sharing database (2000–2018) to identify transplants with >5 (n = 1526) or ≤5 h (n = 35,733) of donor heart preservation. In transplanted hearts preserved for >5 h, Cox‐proportional hazards identify modifiers for survival. Results: Compared to ≤5 h, transplanted patients with >5 h of preservation spent less time in status 1B (76 ± 160 vs. 85 ± 173 days, p =.027), more commonly had ischemic cardiomyopathy (42.3% vs. 38.3%, p =.002), and less commonly received a blood type O heart (45.4% vs. 50.8%, p <.001). Longer heart preservation time was associated with a higher incidence of postoperative stroke (4.5% vs. 2.5%, p <.001), and dialysis (16.4% vs. 10.6%, p <.001). Prolonged preservation was associated with a greater likelihood of death from primary graft dysfunction (2.8% vs. 1.5%, p <.001) but there was no difference in death from acute (2.0% vs. 1.7%, p =.402) or chronic rejection (2.0% vs. 1.9%, p =.618). In transplanted patients with >5 h of heart preservation, multivariable analysis identified greater mortality with ischemic cardiomyopathy etiology (hazard ratio [HR] = 1.36, p < 0.01), pre‐transplant dialysis (HR = 1.84, p <.01), pre‐transplant extracorporeal membrane oxygenation (ECMO, HR = 2.36, p =.09), and O blood type donor hearts (HR = 1.35, p <.01). Conclusion: Preservation time >5 h is associated with worse survival. This mortality risk is further amplified by preoperative dialysis and ECMO, ischemic cardiomyopathy etiology, and use of O blood type donor hearts.
- Subjects
TRANSPLANTATION of organs, tissues, etc.; HEART transplantation; CARDIOMYOPATHIES; STROKE; BLOOD groups; EXTRACORPOREAL membrane oxygenation; HEART
- Publication
Journal of Cardiac Surgery, 2021, Vol 36, Issue 8, p2677
- ISSN
0886-0440
- Publication type
Article
- DOI
10.1111/jocs.15621