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Published on: November 28, 2025
Impact of warm ischemia time on survival after heart transplantation
S F Marasco1, A Kras, E Schulberg
1Cardiothoracic Surgery Unit, The Alfred Hospital, Monash University, Melbourne, Australia. s.marasco@alfred.org.au
Insights
Longer warm ischemia time (WIT) in heart transplantation is linked to reduced patient survival. Donor age also significantly impacts mortality risk, highlighting key factors for improving cardiac transplant outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Outcomes Research
Background:
- Limited data exists on warm ischemia time (WIT) effects compared to cold ischemia.
- Increasing relevance of WIT due to focus on continuous perfusion and non-heart-beating donors.
Purpose of the Study:
- To analyze cardiac transplant outcomes with a specific focus on the impact of warm ischemia time (WIT).
Main Methods:
- Retrospective review of 206 orthotopic heart transplantations (June 2001-November 2010).
- Analysis of donor, recipient, and operative factors.
- Primary outcome variables: all-cause mortality, survival, and primary graft failure.
Main Results:
- Warm ischemia time (WIT) exceeding 80 minutes was associated with reduced survival compared to WIT under 60 minutes.
- Multivariate analysis identified increasing donor age as the most significant predictor of mortality (HR 1.04, P = .004).
Conclusions:
- Increased warm ischemia time (WIT) is demonstrated to reduce survival in heart transplant recipients.
- Findings are particularly relevant for future heart transplantation using organs from non-heart-beating donors.
Background:
There is little data available on the specific effects of warm ischemia time (WIT) as opposed to cold ischemia or storage time. With current research endeavors focusing on warm continuous perfusion, storage of donor hearts, and utilization of hearts from non-heart-beating donors, the impact of WIT on outcomes is increasingly relevant. The aim of this study was to analyze our results in cardiac transplantation with specific focus on the impact of WIT.
Methods:
A retrospective review of 206 patients who underwent orthotopic heart transplantation at our institution between June 2001 and November 2010 was performed. Donor, recipient, and operative factors were analyzed. The main outcome variables were all cause mortality, survival, and primary graft failure.
Results:
WIT of >80 minutes was associated with reduced survival compared with a shorter WIT of <60 minutes. Multivariate analysis showed increasing donor age to be the most significant variable associated with increased risk of mortality (hazard ratio 1.04; P = .004) per year of increasing donor age.
Conclusions:
This study has demonstrated a reduced survival in heart transplant recipients with increased WIT. This finding may be of particular relevance to potential future heart transplantation using organs procured from non-heart-beating donors.
