Wang Chen Chia, Petrovic Mark, Ahmad Awab, Navid Walter, Eidson Christian, Walker Douglas, Harris Timothy, Trahanas John, Bommareddi Swaroop, Nguyen Duc Q, Absi Tarek, Williams Aaron M, Quintana Eric, DeVries Stephen, Siddiqi Hasan, Schlendorf Kelly H, Bacchetta Matthew, Shah Ashish S, Lima Brian
Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
J Thorac Cardiovasc Surg. 2025 Oct;170(4):1109-1116.e3. doi: 10.1016/j.jtcvs.2025.03.037. Epub 2025 May 4.
To clarify the association between warm ischemic time during donation after circulatory death (DCD) and severe primary graft dysfunction (PGD) after heart transplant.
DCD heart transplants using normothermic regional perfusion, excluding congenital etiology or multiorgan transplant, at a single institution from January 2020 to December 2024 were reviewed. Donation withdrawal ischemic time (DWIT), functional warm ischemic time, defined by oxygen saturation <80% (FWIT O), systolic blood pressure <80 mm Hg or <50 mm Hg, and asystolic warm ischemic time were examined. Propensity matching created balanced cohorts to associate warm ischemia and outcomes. Outcomes included incidence of severe PGD, lengths of stay, and mortality.
The final study cohort had 135 patients, of whom 10 of 135 (7.4%) had severe PGD. When stratified by severe PGD, donor and recipient demographics were similar. DWIT (median 25.0 minutes vs 35.5 minutes, P = .031) and FWIT O (median 22.0 vs 33.0 minutes, P = .025) were lower in those without severe PGD. Logistic regression identified FWIT O as a better predictor compared with DWIT. Receiver operating characteristic curve analysis identified a FWIT threshold of 23 minutes (area under the curve, 0.714). After matching, rates of severe PGD were significantly greater in the FWIT O >23 minutes group (8/59 [13.6%] vs 1/59 [1.7%], P = .032). However, the FWIT O >23 minutes group had similar lengths of stay and mortality.
In DCD normothermic regional perfusion heart transplant, >23 minutes of FWIT O is associated with increased rates of severe PGD. However, increased FWIT O was not associated with other outcomes, including mortality. Rejection of allografts on the basis of prolonged warm ischemia may lead to unnecessary discard of viable hearts.
