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The influence of ischemia and reperfusion time on outcome in heart transplantation
Victoria Jernryd1, Carsten Metzsch1, Bodil Andersson2
1Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skane University Hospital, Lund, Sweden.
Insights
Prolonged ischemia increases acute cellular rejection risk after heart transplant. However, extended reperfusion time appears to reduce rejection and improve long-term survival for heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Ischemia/reperfusion injury can cause graft dysfunction in heart transplantation (HT).
- Understanding the impact of ischemic and reperfusion times is crucial for optimizing HT outcomes.
- Acute cellular rejection (ACR) is a significant concern in the first year post-HT.
Purpose of the Study:
- To evaluate the influence of ischemic and reperfusion times on acute cellular rejection (ACR) within the first year post-heart transplantation (HT).
- To assess the impact of these times on long-term survival outcomes after HT.
Main Methods:
- Retrospective analysis of 331 heart transplant recipients from 1988-2016.
- Classification of patients based on ischemic time (
- Assessment of ACR (≥2R) using endomyocardial biopsies (2004-ISHLT-WF) and evaluation of long-term survival.
Main Results:
- Ischemia >4 hours significantly increased the risk of ACR ≥2R within the first year (adjusted OR = 3.1, P = .016).
- Extended reperfusion time ≥90 minutes reduced the risk of ACR (adjusted OR = 0.25, P = .024).
- 10-year survival was lower for recipients with ischemia ≥4 hours and reperfusion <90 minutes (59%) compared to other groups (83%, P = .016).
Conclusions:
- Prolonged ischemia time is associated with a higher risk of acute cellular rejection in the first year post-heart transplant.
- Extended reperfusion time appears to mitigate the risk of ACR and enhance long-term survival.
- Optimizing reperfusion strategies may be key to improving outcomes in heart transplantation.
Abstract:
Ischemia/reperfusion may lead to graft dysfunction in heart transplantation (HT). The purpose of this study was to evaluate the influence of ischemic and reperfusion time on acute cellular rejection (ACR) within the first-year post-HT and on long-term outcomes. Data were collected from 331 patients (mean age 49 ± 12 y, 28% females) who underwent HT 1988-2016. Endomyocardial biopsies obtained within the first year after HT were graded according to the 2004-ISHLT-WF. We classified the patients by ischemic time 4 hours, and of these, 31 (55%) patients had reperfusion with CPB ≥90 minutes. Ischemia >4 hours had an increased risk of ACR ≥ 2R during the first year (adjusted OR = 3.1, P = .016); however, an extended reperfusion ≥90 minutes reduced the risk (adjusted OR = 0.25, P = .024). The conditional probability of surviving 10 years post-transplant, given that the patients already survived first year, was inferior for recipients with ischemia ≥ 4 hours and reperfusion <90 minutes, 59%, compared with the other groups 83%, P = .016. Prolonged reperfusion appears to reduce the risk for ACR ≥ 2R and improve long-term survival.
