Heart Transplantation and Cold Ischemia: Towards Crossing the Border?

Area of Science:

• Cardiology
• Transplantation Surgery
• Organ Preservation

Background:

• Heart transplantation is vital for advanced heart failure treatment.
• Optimizing organ viability through acceptable cold ischemic times is critical for successful outcomes.
• This research examines the impact of prolonged cold ischemia on early mortality post-heart transplant.

Purpose of the Study:

• To investigate the association between cold ischemic time exceeding 4 hours and 30-day mortality following heart transplantation.
• To evaluate the safety and efficacy of using organs with extended cold ischemic periods.

Main Methods:

• A retrospective observational study analyzed medical records of heart transplant recipients from January 2019 to December 2023.
• Inclusion criteria specified the use of histidine-tryptophan-ketoglutarate preservation solution.
• Data collected included recipient demographics, heart failure etiology, procedural details, and 30-day mortality.

Main Results:

• The study included 62 heart transplant recipients (79% male, average age 51).
• Seven patients (≥ 4 hours cold ischemia) had a 43% 30-day mortality rate; 17 of 55 patients (< 4 hours) died (31%).
• Chi-square analysis showed no statistically significant difference in 30-day mortality based on cold ischemic time (P = 0.835).

Conclusions:

• No significant difference in 30-day mortality was observed between heart transplant recipients with cold ischemic times > 4 hours versus < 4 hours.
• These findings suggest potential for expanding donor pool utilization.
• Further strategies are needed to balance allograft availability with patient waiting lists.