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Updated: Jan 1, 2026
Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion
Published on: November 28, 2025
Clinical outcome of donor heart with prolonged cold ischemic time: A single-center study
Fazal Shafiq1, Yixuan Wang1, Geng Li1
1Department of Cardiovascular Surgery, Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
Insights
Extending cold ischemic time beyond 8 hours in heart transplantation may increase complications and mortality. However, cold ischemic times under 8 hours are safe and can expand the donor pool for heart transplants.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Organ Preservation
Background:
- The demand for donor organs for heart transplantation exceeds availability.
- Prolonging the viability of donor hearts during cold ischemic time is crucial.
- Optimizing cold ischemic time is essential for successful orthotopic heart transplantation.
Purpose of the Study:
- To evaluate the short-term outcomes of orthotopic heart transplantation based on varying cold ischemic times.
- To determine the safety and efficacy of extended cold ischemic times in heart transplantation.
- To inform strategies for expanding the donor pool in heart transplantation.
Main Methods:
- Retrospective analysis of heart transplant patients from January 2015 to December 2017.
- Patients categorized into four groups based on cold ischemic time: >8 hours, 6-8 hours, 4-6 hours, and <4 hours.
- Efficacy indicators included post-transplant survival, infection rates, rejection rates, and complications.
Main Results:
- Donor and recipient characteristics were similar across all groups.
- Cold ischemic times >8 hours correlated with increased cardiopulmonary bypass (CPB) time, CPB-assist time, and higher intra-aortic balloon pump (IABP) usage.
- A trend towards higher mortality was observed with cold ischemic times >8 hours, although not statistically significant (P > 0.05).
- Two-year survival rates were comparable across groups, with slight variations.
Conclusions:
- Cold ischemic times less than 8 hours are safe and can be utilized to expand the donor pool for heart transplantation.
- Extended cold ischemic times (>8 hours) may lead to increased CPB time, CPB-assist time, and postoperative IABP use.
- Prolonged cold ischemic time might negatively impact in-hospital and 2-year survival rates.
Objectives:
Due to the shortage of donor pool, there has been a need for organs with prolonged cold ischemic time. This study aims to evaluate the short-term results of different cold ischemic times in orthotopic heart transplantation based on a single-center experience in China.
Methods:
We retrospectively analyzed outcomes of the heart transplant patients from 1 January 2015 to 31 December 2017. The recipient population was divided into four groups. Group 1: cold ischemic time greater than 8 hours; group 2: the cold ischemic time between 6 and 8 hours; group 3: the cold ischemic time between 4 and 6 hours; and group 4: cold ischemic time less than 4 hours. Efficacy indicators included after transplant survival, infection rate, rejection rate, and complications.
Results:
The four groups have similar donor and recipient baseline characteristics (P > .05). Cold ischemic time greater than 8 hours had more cardiopulmonary bypass (CPB) time (127.62 ± 50.23 minutes; P = .003), CPB-assist time (86.14 ± 36.74 minutes; P = .047), and higher intra-aortic balloon pump (IABP) usage rate postoperatively (47.36%; P = .010). Cold ischemic time greater than 8 hours witnessed a relatively higher mortality rate compared with the other three groups (P = .115, P = .078, and P = .114) during the 2-year follow-up. Survival rates of 1 and 2 years for the four groups were 78.95%, 87.13%, 87.32%, and 87.50% and 68.42%, 85.14%, 85.92%, and 83.93%, respectively.
Conclusion:
Cold ischemic time less than 8 hours can be reasonably applied to expand the heart transplantation donor pool. Cold ischemic time greater than 8 hours might result in longer CPB time, CPB-assist time, and higher IABP usage postoperatively. It might also affect the in-hospital and 2-years survival rate.
