The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2025
Ten-minute asystolic warm ischemic time (AWIT) predicts mortality and severe primary graft dysfunction in donation after circulatory death hearts recovered with thoracoabdominal normothermic regional perfusion.
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Williams Aaron M, Ahmad Awab, Trahanas John, Bommareddi Swaroop, Absi Tarek, Quintana Eric, Wang Chen Chia, Petrovic Mark, McGann Kevin, Devries Stephen, Lowman Joshua, Siddiqi Hasan, Amancherla Kaushik, Brinkley Marshall, Menachem Jonathan N, Pedrotty Dawn, Punnoose Lynn, Rali Aniket S, Sacks Suzanne, Zalawadiya Sandip, Bacchetta Matthew, Schlendorf Kelly, Shah Ashish S, Lima Brian
Аннотация
BACKGROUND: Donor warm ischemic time (WIT) during donation after circulatory death (DCD) has been linked to adverse outcomes in noncardiac transplants, but its impact on heart transplant recipients remains unclear. This study evaluated the association between prolonged WIT and outcomes in adult recipients of thoracoabdominal normothermic regional perfusion (NRP)-recovered cardiac allografts.
METHODS: We retrospectively reviewed adult heart transplant recipients who received NRP-recovered DCD allografts at a single center between October 2020 and February 2025. WIT was defined as (1) withdrawal of life support to NRP initiation (donor WIT), (2) functional WIT to NRP, using 3 thresholds-SpO2 <80%, systolic blood pressure (SBP) <80 mm Hg, and SBP <50 mm Hg, and (3) asystole to NRP (asystolic warm ischemic time [AWIT]). Univariable and adjusted Cox regressions assessed mortality risk; logistic and linear regressions were used for other outcomes.
RESULTS: One hundred and forty-three recipients were included in the study. Among ischemic intervals, AWIT ≥ 10 minutes independently increased the risk of 90-day mortality (hazard ratio [HR]: 6.42 [1.93-31.91], p = 0.03), 30-day mortality (HR: 8.87 [2.06-82.26], p = 0.04), severe primary graft dysfunction (PGD) (odds ratio [OR]: 2.99 [1.29-7.61], p = 0.01) and postbypass right ventricular, increased vasoactive inotrope score and decreased cardiac indices at 72 hours (p < 0.05). Furthermore, donor AWIT ≥ 10 minutes was associated with increased risk of post-transplant renal replacement and longer hospital length of stay (p < 0.05).
CONCLUSIONS: A 10-minute AWIT appears to predict mortality and severe PGD and other recipient outcomes in NRP-recovered DCD hearts. Efforts to minimize AWIT are crucial to optimize postoperative recipient outcomes.
METHODS: We retrospectively reviewed adult heart transplant recipients who received NRP-recovered DCD allografts at a single center between October 2020 and February 2025. WIT was defined as (1) withdrawal of life support to NRP initiation (donor WIT), (2) functional WIT to NRP, using 3 thresholds-SpO2 <80%, systolic blood pressure (SBP) <80 mm Hg, and SBP <50 mm Hg, and (3) asystole to NRP (asystolic warm ischemic time [AWIT]). Univariable and adjusted Cox regressions assessed mortality risk; logistic and linear regressions were used for other outcomes.
RESULTS: One hundred and forty-three recipients were included in the study. Among ischemic intervals, AWIT ≥ 10 minutes independently increased the risk of 90-day mortality (hazard ratio [HR]: 6.42 [1.93-31.91], p = 0.03), 30-day mortality (HR: 8.87 [2.06-82.26], p = 0.04), severe primary graft dysfunction (PGD) (odds ratio [OR]: 2.99 [1.29-7.61], p = 0.01) and postbypass right ventricular, increased vasoactive inotrope score and decreased cardiac indices at 72 hours (p < 0.05). Furthermore, donor AWIT ≥ 10 minutes was associated with increased risk of post-transplant renal replacement and longer hospital length of stay (p < 0.05).
CONCLUSIONS: A 10-minute AWIT appears to predict mortality and severe PGD and other recipient outcomes in NRP-recovered DCD hearts. Efforts to minimize AWIT are crucial to optimize postoperative recipient outcomes.