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Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Donor age and ischemic time in heart transplantation - implications for organ preservation
Victoria Jernryd1, Josef Stehlik2, Carsten Metzsch1
1Department of Clinical Sciences Lund, Thoracic Surgery, Lund University, Lund, Sweden; Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Lund, Sweden; Department of Translational Medicine, Thoracic Surgery and Bioinformatics, Lund University, Lund, Sweden.
Insights
Heart transplant survival is impacted by donor age and ischemic time. A new nomogram helps predict outcomes, suggesting ex-vivo preservation for older donors with longer preservation times.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Biostatistics
Background:
- Advancements in heart transplantation include the Organ Care System and non-ischemic heart preservation.
- These methods aim to reduce ischemic injury and extend preservation duration.
- High costs and logistical challenges necessitate strategic application of these preservation techniques.
Purpose of the Study:
- To investigate the impact of donor age and ischemic time on heart transplant recipient survival.
- To develop a predictive nomogram for post-transplant survival based on donor characteristics and ischemic duration.
Main Methods:
- Analysis of 83,761 heart transplants from the International Society for Heart and Lung Transplantation registry (1988-2018).
- Application of Cox proportional hazards modeling to assess donor age and ischemic time effects.
- Development of a nomogram integrating traditional and advanced statistical methods for survival prediction.
Main Results:
- Median donor age was 33 years; median recipient age was 52 years.
- Median ischemic time was 3 hours, with a median survival of 11.5 years.
- Increased donor age (≥40 years) and prolonged ischemic time (>4 hours) correlated with reduced survival probabilities. Hazard ratios increased significantly for older donors with longer ischemic times.
Conclusions:
- Donor selection is critical for heart transplant success.
- Older donors with extended ischemic times may benefit from advanced preservation strategies.
- The developed nomogram serves as a clinical tool for optimizing donor-recipient matching and predicting transplant outcomes.
Background:
The Organ Care System and Non-ischemic Heart Preservation methods have emerged as significant advancements in heart transplantation, designed to mitigate ischemic injury and extend preservation times. However, their high costs and logistical complexities necessitate strategic utilization.
Methods:
We evaluated data from 83,761 heart transplants registered in the International Society for Heart and Lung Transplantation registry from 1988 to 2018. Utilizing a Cox proportional hazards model, we explored the influence of donor age and ischemic time on transplant survival. A key innovation of our study is the development of a nomogram to predict post-transplant survival, incorporating both traditional and advanced statistical methods.
Results:
The median age of recipients was 52 years (22% female) and 33 years (31% female) for donors. Analysis revealed a median ischemic time of 3 hours and median survival of 11.5 years across the cohort. The nomogram showed a decline in survival probabilities with increasing donor age, notably from age 40 and more significantly with ischemic times >4 hours. Ischemic times ≥4 hours versus <2 hours were associated with hazard ratio (HR) of 1.2 (95% CI, 1.1-1.3) for donors aged 40-59, a disparity that escalated for donors aged ≥60 (HR: 2.0; 95% CI, 1.5-2.7).
Conclusions:
This study highlights the importance of careful donor selection and indicates that certain groups, particularly older donors with prolonged ischemic times, might benefit from ex-vivo preservation techniques. The developed nomogram offers a practical tool for clinicians, enhancing decision-making by providing detailed insights into the relationship between donor age, ischemic time, and post-transplant mortality.
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