Interaction Between Ischemic Time and Donor Age on Adult Heart Transplant Outcomes in the Modern Era

Abstract

Background. We examined the effect of cold ischemic interval on modern outcomes to determine whether advances in patient management have made an impact.Methods. Using the United Network of Organ Sharing database, we reviewed adult heart transplants between January 2000 and March 2016. We divided donor age into terciles: younger than 18 years, 18 to 33 years, and 34 years and older. Within each tercile, transplants were divided by cold ischemic interval of less than 4 hours, 4 to 6 hours, and more than 6 hours. Survival curves were compared between cold ischemic interval categories within each tercile. Covariate-adjusted and donor age-stratified Cox proportional hazards regression models were used to estimate overall mortality and graft failure hazards ratios.Results. Of 29,192 transplants, no significant differences between cold ischemic interval groups in survival or graft failure were apparent in the group aged younger than 18. For donors older than 18, significant differences were found for survival and graft failure with cold

Extracorporeal membrane oxygenation bridge to heart transplant: Trends following the allocation change

“…These findings highlight the importance of careful patient selection and end‐organ protection before OHT to increase the odds of survival in this high‐risk population. In addition, we found increasing graft cold ischemic time to be a predictor of increased mortality, a finding that has been well studied in other OHT subgroups 11 …”

“…In addition, we found increasing graft cold ischemic time to be a predictor of increased mortality, a finding that has been well studied in other OHT subgroups. 11…”

“…8 Proposed explanations for these findings are (1) priority given to the sickest patients in a now six-tier allocation system and (2) wider sharing of organs with the potential for increased procurement distances and graft ischemic times, which are associated with decreased survival and increased risk of primary graft dysfunction. [9][10][11] In the current system, patients supported with ECMO are given a tier-one status, which may decrease waitlist times and increase the likelihood of transplant. The purpose of this study was to study the effects of the allocation policy change on the rates of ECMO utilization, as well its effects on waitlist mortality in the ECMO-supported patient.…”

Experience of heart transplantation with an extended cold ischemic time of donor heart

“…Наши коллеги из США представили более противоречивые данные, согласно которым более старший возраст донора, вне зависимости от длительности холодовой ишемии донорского сердца, является предиктором смертности. А увеличение длительности холодовой ишемии донорского сердца до 6 ч, является оптимальным вариантом для реципиентов в критическом состоянии [3].…”

“…Уровень инотропной поддержки на момент остановки искусственного кровообращения представлен инотропным индексом, при этом значимой разницы между двумя группами не было выявлено (p=0,13). Медиана инотропного индекса в 1-й группе 8 (4-14,75), во 2-й 6,75 (3,.…”