The Importance of Cold and Warm Cardiac Ischemia for Survival After Heart Transplantation
- 27 August 2008
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Transplantation
- Vol. 86 (4), 542-547
- https://doi.org/10.1097/tp.0b013e31818149b9
Abstract
Ischemia time is a risk factor for mortality after heart transplantation that can be influenced by organizational factors such as transport arrangements and organ allocation. We used the United Kingdom Cardiothoracic Transplant Audit database to analyze the outcome of 1491 first isolated orthotopic adult heart transplants performed between April 1995 and March 2004. Ischemia time and its components (transport time and surgical implant time) were related to 30-day mortality using a multivariable logistic regression model. The median total ischemia time increased from 171 min (interquartile range: 149-198) to 213 min (interquartile range: 181-256) during the study period (P<0.0001). This was due to an increase in transport times that was partly explained by increased organ exchange between centers and also because of an increase in surgical implant times. Thirty-day survival decreased over the study period (91%-84%) with some evidence of a linear trend towards decreasing survival over time (P=0.089). After correcting for other known risk factors, the odds ratio of death within 30 days associated with each 15 min increment in transport time was 1.06 (95% confidence interval: 1.01-1.12) and with each 15 min increment in surgical implant time was 1.11 (95% confidence interval: 1.04-1.18). Both transport and implant times were directly related to 30-day mortality after heart transplantation. Ischemia time should be considered in organ allocation and controlled during the heart transplant procedure.Keywords
This publication has 11 references indexed in Scilit:
- 342: Predicting death due to primary graft dysfunction in adult heart transplantationThe Journal of Heart and Lung Transplantation, 2007
- Registry of the International Society for Heart and Lung Transplantation: Twenty-third Official Adult Heart Transplantation Report—2006The Journal of Heart and Lung Transplantation, 2006
- Outcome of hearts with cold ischemic time greater than 300minutes. A case-matched study☆European Journal of Cardio-Thoracic Surgery, 2005
- Prolonged donor ischemic time does not adversely affect long-term survival in adult patients undergoing cardiac transplantationThe Journal of Thoracic and Cardiovascular Surgery, 2003
- Evolving trends in risk profiles and causes of death after heart transplantation: A ten-year multi-institutional studyThe Journal of Thoracic and Cardiovascular Surgery, 2003
- Heart preservation for transplantation: principles and strategiesThe Annals of Thoracic Surgery, 1999
- The role of donor age and ischemic time on survival following orthotopic heart transplantationThe Journal of Heart and Lung Transplantation, 1999
- Total orthotopic heart transplantation: An alternative to the standard techniqueThe Annals of Thoracic Surgery, 1991
- Long-Distance Transportation of Human Hearts for TransplantationThe Annals of Thoracic Surgery, 1978
- OXYGEN CONSUMPTION OF ANIMALS AND TISSUES AS A FUNCTION OF TEMPERATUREThe Journal of general physiology, 1959