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Updated: May 6, 2026
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Impact of controlled hypothermic preservation on outcomes following heart transplantation
David D'Alessandro1, Jacob Schroder2, Dan M Meyer3
1Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Insights
Controlled hypothermic preservation significantly reduces severe primary graft dysfunction (PGD) after heart transplants compared to traditional ice storage. This method improves survival by mitigating PGD, a major cause of early mortality.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Organ Preservation
Background:
- Severe primary graft dysfunction (PGD) is a critical factor in early mortality following heart transplantation.
- The influence of donor organ preservation techniques on PGD severity and patient survival remains incompletely understood.
Purpose of the Study:
- To investigate the impact of different organ preservation methods on the incidence and severity of PGD.
- To analyze the association between preservation conditions, PGD, and 1-year mortality after heart transplantation.
Main Methods:
- Analysis of data from US adult heart transplant recipients (NCT04141605).
- Comparison of traditional ice storage versus controlled hypothermic preservation.
- Propensity matching and logistic regression were used to analyze PGD severity, mortality, and risk factors, including ischemic time.
Main Results:
- Controlled hypothermic preservation was associated with a significant reduction in severe PGD incidence (6.6% vs 10.4%, p=0.039).
- Propensity matching confirmed a 50% reduction in severe PGD with controlled hypothermic preservation (6.0% vs 12.1%, p=0.018).
- Severe PGD significantly increased 1-year mortality risk (32.1% vs 4.2% for no PGD, p<0.001), with ice storage showing higher PGD rates across all ischemic times.
Conclusions:
- Severe PGD is the leading cause of mortality post-heart transplant, increasing 1-year mortality risk 7.8-fold.
- Controlled hypothermic preservation effectively reduces the risk of severe PGD.
- This preservation method offers a simple yet potent strategy to decrease post-transplant complications and improve patient outcomes.
Background:
Severe primary graft dysfunction (PGD) is a major cause of early mortality after heart transplant, but the impact of donor organ preservation conditions on severity of PGD and survival has not been well characterized.
Methods:
Data from US adult heart-transplant recipients in the Global Utilization and Registry Database for Improved Heart Preservation-Heart Registry (NCT04141605) were analyzed to quantify PGD severity, mortality, and associated risk factors. The independent contributions of organ preservation method (traditional ice storage vs controlled hypothermic preservation) and ischemic time were analyzed using propensity matching and logistic regression.
Results:
Among 1,061 US adult heart transplants performed between October 2015 and December 2022, controlled hypothermic preservation was associated with a significant reduction in the incidence of severe PGD compared to ice (6.6% [37/559] vs 10.4% [47/452], p = 0.039). Following propensity matching, severe PGD was reduced by 50% (6.0% [17/281] vs 12.1% [34/281], respectively; p = 0.018). The Kaplan-Meier terminal probability of 1-year mortality was 4.2% for recipients without PGD, 7.2% for mild or moderate PGD, and 32.1%, for severe PGD (p < 0.001). The probability of severe PGD increased for both cohorts with longer ischemic time, but donor hearts stored on ice were more likely to develop severe PGD at all ischemic times compared to controlled hypothermic preservation.
Conclusions:
Severe PGD is the deadliest complication of heart transplantation and is associated with a 7.8-fold increase in probability of 1-year mortality. Controlled hypothermic preservation significantly attenuates the risk of severe PGD and is a simple yet highly effective tool for mitigating post-transplant morbidity.
