Williams Aaron M, Ahmad Awab, Trahanas John, Bommareddi Swaroop, Absi Tarek, Quintana Eric, Wang Chen Chia, Petrovic Mark, McGann Kevin, Devries Stephen, Lowman Josh, 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
Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN.
Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN.
J Heart Lung Transplant. 2025 Jul 21. doi: 10.1016/j.healun.2025.07.015.
Donor warm ischemic time (WIT) during donation after circulatory death (DCD) has been linked to adverse outcomes in non-cardiac 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.
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 (WLS) to NRP initiation (DWIT), (2) functional WIT (FWIT) to NRP, using three thresholds-SpO₂ <80%, SBP <80 mmHg, and SBP <50 mmHg, and (3) asystole to NRP (AWIT). Univariable and adjusted Cox regressions assessed mortality risk; logistic and linear regressions were used for other outcomes.
143 recipients were included in the study. Among ischemic intervals, AWIT ≥ 10 minutes independently increased the risk of 90-day mortality (HR: 6.42 (1.93-31.91), p = 0.03), 30-day mortality (HR: 8.87 (2.06-82.26), p = 0.04), severe PGD (OR: 2.99 (1.29-7.61), p = 0.01) and post bypass RV, 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).
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.
