The Effect of Cardiac Preservation Solutions on Heart Transplant Survival

Abstract

Background: Limited data exist that compare the predominant cardiac preservation solutions (CPSs). Materials and methods: The United Network for Organ Sharing database was retrospectively reviewed from January 1, 2004 to March 31, 2018, for donor hearts. Of 34,614 potential donors, 21,908 remained after applying the exclusion criteria. The CPS analyzed included saline, the University of Wisconsin (UW), cardioplegia, Celsior, and Custodiol. The primary endpoints were recipient survival and posttransplant rejection. Logistic and Cox models were used to quantify survival endpoints. Results: Saline was used as the CPS in 2549 patients (12%), UW in 10,549 (48%), cardioplegia in 1307 (6%), Celsior in 5081 (23%), and Custodiol in 2422 (11%). Donor age ranged from 15 to 68 y (mean ¼ 32.0 y, median ¼ 30.0 y), and 71% were male. Adjusted survival probabilities of recipients whose donor hearts were procured with saline was 96% 30 d, 90% 1 y, UW: 97% 30 d, 92% 1 y, cardioplegia: 95% 30 d, 87% 1 y, Celsior: 96% 30 d, 90% 1 y, and Custodiol: 97% 30 d, 92% 1 y. When these comparisons were adjusted for donor age, sex, ethnicity, ischemic time, recipient age, sex, ethnicity, creatinine, ventricular assist device (VAD), length of stay, region and days on waiting list, cardioplegia solution was demonstrated to have a higher risk of death (30 d, 1 y, overall) and posttransplant rejection versus UW (odds ratio 1.70, P ¼ 0.001; odds ratio 1.63, P < 0.001; hazard ratio 1.22, P < 0.001; hazard ratio 1.21, P < 0.001, respectively). Conclusions: Cardioplegia solutions for cardiac preservation are associated with a higher mortality in heart transplant recipients.

Does pediatric heart transplant survival differ with various cardiac preservation solutions?

“…In contrast to cardiac preservation solutions utilized in adult cardiac transplantation, 5 when comparing preservation solutions in the pediatric population, no significant differences were detected in 30‐day survival, 1‐year survival, or episodes of post‐transplant rejection in adjusted models based on preservation solution. This study reveals that significant variability continues to exist among institutions regarding preservation solution preferences, even variation between adult and pediatric transplants at the same institution.…”

“…Analyses closely mirrored analyses undertaken by Carter et al 5 in evaluating the effects of preservation solution in adult cardiac transplantation. Multivariable logistic models were employed for 30‐day and 1‐year survival outcomes.…”

“…Carter et al 5 studied effects of cardiac preservation solution on recipient outcomes in the adult heart transplant population. The investigators found that, although there was no single optimal solution, cardioplegia was clearly inferior when compared to UW.…”

“…In contrast to cardiac preservation solutions utilized in adult cardiac transplantation, 5 or not-for-profit sectors.…”

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

“…При этом необходимо минимизировать внеклеточный и внутриклеточный отек, внутриклеточный ацидоз, уменьшить образование свободных радикалов, которые способствуют повреждению миокарда трансплантата и, тем самым, снижают жизнеспособность миокарда. Проводится множество исследований, направленных на оптимизацию методов консервации, чтобы увеличить безопасное время холодовой ишемии трансплантата и уменьшить повреждение миокарда, связанное с длительной ишемией [7].…”