Related Experiment Video
Updated: Aug 6, 2026
Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion
Published on: November 28, 2025
Donor Heart Preservation at 10 °C Outperforms 4-8 °C With Improved Early Graft Function in Adult Heart
Aaron M Williams1, Brian Lima1, Abigail Benkert2
1Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN (A.M.W., B.L., A.A., S.B., J.T., C.C.W., K.C.M.G., M.P., S.D., J.L., K.S., M.B., A.S.S.).
Background:
Static cold storage of cardiac allografts at 4-8 °C or 10 °C has yielded promising heart transplant outcomes compared with ice storage. However, direct comparisons between these 2 preservation temperatures are lacking. This dual-center study is the first to compare adult heart transplant outcomes using allografts preserved at 10 °C versus 4-8 °C static cold storage.
Methods:
All single-organ, donation-after-brain-death adult heart transplants performed at 2 high-volume centers between January 2020 and April 2025 were retrospectively analyzed. Multiorgan, adult congenital, and donation-after-circulatory-death cases were excluded. A 3:1 nearest-neighbor propensity score matching was applied using a standardized mean difference <20% to create balanced cohorts. Firth logistic regression and quantile regression were used to evaluate categorical and continuous outcomes in unmatched and matched cohorts.
Results:
Among 365 recipients, 113 received allografts preserved at 10 °C and 252 at 4-8 °C. The 10 °C group had higher donor and recipient risk profiles, including older donors (37 [28-43] versus 31 [24-39] years; P=0.004), greater donor-recipient sex mismatch, and more frequent donor undersizing by predicted heart mass ratio. Recipients in this cohort were older and had more re-sternotomies and higher serum creatinine levels at transplant. Patients in the 4-8 °C group were more often listed as Status 2. After matching, 10 °C preservation was associated with less primary graft dysfunction (2 [2.9%] versus 19 [14.6%]; P=0.008), less left and right ventricular dysfunction, reduced new intraaortic balloon pump use, and improved 1-year survival (95.7% versus 86.2%; P=0.02). Other outcomes, including cardiac indices and posttransplant length of stay, were not significantly different between groups.
Conclusions:
Preservation of cardiac allografts at 10 °C may yield superior early graft function compared with 4-8 °C static cold storage. However, further prospective studies are required to delineate the optimal donor heart preservation temperature.
