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Updated: Aug 17, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Outcome of hearts with cold ischemic time greater than 300 minutes. A case-matched study
Fotios A Mitropoulos1, Jonah Odim, Daniel Marelli
1Heart Transplant Program, University of California, Los Angeles Medical Center, Los Angeles, CA, USA. fmitropoulos@sprintmail.com
Insights
Utilizing donor hearts with prolonged ischemia time (>300 min) in heart transplantation is safe. Careful matching and preservation techniques ensure comparable outcomes to shorter ischemia times.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Organ Preservation
Background:
- Expanding the donor pool for heart transplantation is crucial.
- Prolonged ischemic time for cardiac allografts raises concerns about graft failure and transplant coronary artery disease.
Purpose of the Study:
- To evaluate the outcomes of heart transplantation using donor allografts with prolonged ischemia time (>300 minutes).
- To compare graft survival, rejection rates, and incidence of transplant coronary artery disease between prolonged and standard ischemia time groups.
Main Methods:
- Retrospective analysis of 46 heart transplant recipients with ischemia time >300 minutes.
- Case-matched control group of 46 recipients with standard ischemia time.
- Comparison of mortality, acute cellular rejection, and transplant coronary artery disease incidence.
- Allografts preserved using University of Wisconsin solution.
Main Results:
- No significant difference in 30-day or late mortality between groups (9% vs 7.4% per year).
- Similar rates of acute cellular rejection (2% vs 4.5%) and transplant coronary artery disease (4.3% vs 5.4%) at one year.
- Mean ischemia times were 388 minutes (study) vs 173 minutes (control).
Conclusions:
- Donor hearts with ischemia time >300 minutes yield comparable early and intermediate outcomes.
- Judicious donor-recipient matching and advanced preservation techniques are key.
- Prolonged ischemia time does not adversely affect transplant outcomes with current management strategies.
Objective:
Expansion of potential donor pool may be facilitated by using cardiac allografts with long ischemic time. Early graft failure and potential relation to transplant coronary artery disease remains a concern. We sought to evaluate outcomes of heart transplantation in recipients of donor allografts with prolonged ischemia time.
Methods:
The study group consisted of 46 (mean age, 52 years) consecutive patients at UCLA from 1994 to 2002 that underwent heart transplantation with ischemia time > 300 min. This group was compared to a case-matched control group of 46 (mean age, 51 years) patients identified from our database during this time frame for the following factors: UNOS status, congenital heart disease diagnosis, preop inotropes, pretransplantation creatinine > 1.5 and recipient age. Primary endpoint was mortality and secondary were rejection rate and transplant coronary artery disease. Allografts were perfused and stored in cold University of Wisconsin solution.
Results:
Mean donor ages of the study and case-matched control group were 34+/-15 and 34+/-14 years, respectively. Mean ischemia times were 388 (range, 301-600 min) and 173 (range, 96-236 min), respectively. The death incidence rate per 100 transplants per year was 9% for the study group and 7.4% for the matched group (P = 0.50). Thirty-day mortality for the study and case-matched groups were 4.3 and 2.1%, respectively (P = 0.9). Late mortality was 16.5 and 18.5%, respectively (P = 0.9). The risk of death after 30 days was 7.5 and 5.8%, respectively (P = 0.5, log-rank). One-year incidence of acute cellular rejection in the study and case-matched groups were 2 and 4.5% (P = 0.36), respectively. One-year incidence of transplant coronary artery disease in the study and case-matched groups were 4.3 and 5.4%, respectively (P = 0.68).
Conclusions:
Donor hearts with ischemia time greater than 300 min provide comparable early and intermediate outcomes given judicious and careful donor and recipient matching and our current techniques of myocardial preservation and modified reperfusion.
