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Prolonged donor ischemic time does not adversely affect long-term survival in adult patients undergoing cardiac
Jeffrey A Morgan1, Ranjit John, Alan D Weinberg
1Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. Jm2240@columbia.edu
Insights
Prolonged donor ischemic time in heart transplantation does not negatively impact long-term survival. This finding supports using organs with longer ischemic times to expand the donor pool and meet recipient demand.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Procurement
Background:
- Donor eligibility criteria liberalization leads to increased donor ischemic times.
- Limited research exists on the long-term survival impact of prolonged donor ischemic times in cardiac transplantation.
Purpose of the Study:
- To evaluate the long-term survival outcomes of cardiac transplant recipients based on varying donor ischemic times.
Main Methods:
- Retrospective analysis of 819 adult cardiac transplant recipients over 11 years.
- Patients categorized into four groups based on donor ischemic time (<150, 150-200, 200-250, >250 minutes).
- Kaplan-Meier survival and Cox proportional hazard models used to assess long-term survival predictors.
Main Results:
- No significant differences in recipient or donor demographics across the four ischemic time groups.
- Prolonged donor ischemic time did not adversely affect 1-, 5-, or 10-year actuarial survival rates.
- No significant difference in freedom from transplant coronary artery disease was observed among the groups.
Conclusions:
- Prolonged donor ischemic time is not a risk factor for reduced long-term survival in cardiac transplant recipients.
- Procurement of hearts with extended donor ischemic times is justifiable given the growing recipient pool and limited donor availability.
Objective:
With liberalization of donor eligibility criteria, organs are being harvested from remote locations, increasing donor ischemic times. Although several studies have evaluated the effects of prolonged donor ischemic times on short-term survival and graft function, few have addressed concerns regarding long-term survival.
Methods:
Over the last 11 years, 819 consecutive adults underwent cardiac transplantation at Columbia Presbyterian Medical Center. Recipients were separated into the following 4 groups based on donor ischemic time: <150 minutes, 150 to 200 minutes, 200 to 250 minutes, and >250 minutes. Statistical analysis included Kaplan-Meier survival and Cox proportional hazard models to identify predictors of long-term survival.
Results:
Donor ischemic time was 120.1 +/- 21.1 minutes for group 1 (n = 321), 174.1 +/- 14.7 minutes for group 2 (n = 264), 221.7 +/- 14.6 minutes for group 3 (n = 154), and 295.5 +/- 37.1 minutes for group 4 (n = 80) (P <.001). There were no significant differences in recipient age, donor age, etiology of heart failure, United Network for Organ Sharing status, or history of previous cardiac surgery among the groups (P = NS). Prolonged donor ischemic time did not adversely affect long-term survival, with actuarial survival at 1, 5, and 10 years of 86.9%, 75.2%, and 56.4% for group 1; 86.2%, 76.9%, and 50.9% for group 2; 86.4%, 71.0%, and 43.7% for group 3; and 86.7%, 70.1%, and 50.9% for group 4 (P =.867). There was no significant difference in freedom from transplant coronary artery disease among the 4 groups (P =.474).
Conclusions:
Prolonged donor ischemic time is not a risk factor for decreased long-term survival. Procurement of hearts with prolonged donor ischemic time is justified in the setting of an increasing recipient pool with a fixed donor population.
