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Correlation Between the Distance From Donors and Ischemic Time in Heart Transplantation of Korea and Its Clinical
Jung Yeon Jin1, Chee-Hoon Lee1, Mi Hee Lim1
1Division of Thoracic and Cardiovascular Surgery, Department of Cardiovascular Surgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Insights
Regional priority in South Korea's heart transplant system does not impact patient outcomes. Despite longer ischemic times in inter-region transplants, survival rates and clinical results were similar to intra-region procedures.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Policy
Background:
- South Korea's heart donor allocation prioritizes recipients within the same region.
- The clinical impact of reduced ischemic time (IT) from intra-region heart transplantation (HT) is not well-established.
- This study compares outcomes of intra-region versus inter-region HT.
Purpose of the Study:
- To compare the characteristics and clinical outcomes of intra-region and inter-region heart transplantation.
- To evaluate the significance of donor location on heart transplant success in South Korea.
Main Methods:
- Retrospective analysis of 115 adult patients undergoing isolated heart transplantation (2014-2022).
- Comparison of intra-region (n=58) and inter-region (n=57) HT groups.
- Analysis of preoperative characteristics, inter-hospital distance, total ischemic time, and postoperative outcomes.
Main Results:
- Inter-region HT had significantly longer inter-hospital distances and total ischemic times.
- No significant differences were observed in 30-day mortality, postoperative cardiac index, early adverse events, or long-term survival.
- A strong positive correlation was found between inter-hospital distance and cold ischemic time.
Conclusions:
- Donor location and associated ischemic time differences do not significantly affect heart transplant outcomes in South Korea.
- The current regional allocation system's impact on patient outcomes appears minimal.
- Further research may explore other factors influencing heart transplant success.
Background:
The heart donor allocation system in South Korea is divided into three regions, with priority given to recipients within the same region over those in other regions of the same tier. It is commonly believed that heart transplantation (HT) within the same region can reduce ischemic time (IT), although its clinical impact remains unclear. The purpose of this study is to compare the characteristics and outcomes of intra-region HT and inter-region HT.
Methods:
From 2014 to 2022, a total of 115 adult patients underwent isolated HT at a tertiary hospital. Of these, 58 recipients (54.5 ± 10.3 years, female, 36.2%) underwent intra-region HT and 57 recipients (53.9 ± 14.1 years, female, 31.6%) underwent inter-region HT. Extracorporeal membrane oxygenation-bridged HTs accounted for 50.0% and 54.4% of cases, respectively (P = 0.638). There were no differences in preoperative characteristics between the two groups.
Results:
The median inter-hospital distance (38.0 [32.0-112.0] km vs. 351.0 [300.0-390.5] km, P < 0.001) and total IT (153 [123-170] minute vs. 265 [243-298] minute, P < 0.001) were longer in the inter-region group than intra-region group. Despite these differences, both groups showed similar clinical outcomes. The 30-day mortality rates were 5.2% and 5.3% (P < 0.99), respectively. There were no differences in postoperative cardiac index, early adverse outcomes, or long-term survival between the two groups. The inter-hospital distance and cold IT showed a strong positive correlation (time [minute] = 39.462 + 0.410 × distance [km]).
Conclusion:
Despite the difference in IT, there was no difference in postoperative outcomes between the two groups. Based on these findings, the effect of donor location on the outcomes of HT in South Korea is not considered significant.
