Effects of ex vivo machine perfusion on preservation time and donor age in donation after brain death heart transplantation.

With encouraging early experience, ex vivo machine perfusion (MP) systems are increasingly employed in heart transplantation. In this study, utilizing a national registry database, 2 separate analyses were performed to evaluate the effects of MP on graft preservation time (total n = 22,794; n = 308 with MP) and donor age (total n = 22,581; n = 95 with MP) in donation after brain death (DBD) heart transplantation. The cohort was stratified based on total preservation time (<4 and ≥4 hours) and donor age (<45 and ≥45 years). During the study period, the use of MP in isolated DBD heart transplantation significantly increased. Utilization of MP was associated with improved 90-day post-transplant survival among the recipients with preservation times ≥4 hours or donor age ≥45 years, compared to cases where MP was not utilized. These findings positively highlight the potential utility of ex vivo MP in DBD heart transplantation involving longer graft preservation times and in older donors.