Prolonged donor ischemic time does not adversely affect long-term survival in adult patients undergoing cardiac transplantation.
OBJECTIVE
With liberalization of donor eligibility criteria, organs are being harvested from remote locations, increasing donor ischemic times. Although several studies have evaluated the effects of prolonged donor ischemic times on short-term survival and graft function, few have addressed concerns regarding long-term survival.


METHODS
Over the last 11 years, 819 consecutive adults underwent cardiac transplantation at Columbia Presbyterian Medical Center. Recipients were separated into the following 4 groups based on donor ischemic time: <150 minutes, 150 to 200 minutes, 200 to 250 minutes, and >250 minutes. Statistical analysis included Kaplan-Meier survival and Cox proportional hazard models to identify predictors of long-term survival.


RESULTS
Donor ischemic time was 120.1 +/- 21.1 minutes for group 1 (n = 321), 174.1 +/- 14.7 minutes for group 2 (n = 264), 221.7 +/- 14.6 minutes for group 3 (n = 154), and 295.5 +/- 37.1 minutes for group 4 (n = 80) (P <.001). There were no significant differences in recipient age, donor age, etiology of heart failure, United Network for Organ Sharing status, or history of previous cardiac surgery among the groups (P = NS). Prolonged donor ischemic time did not adversely affect long-term survival, with actuarial survival at 1, 5, and 10 years of 86.9%, 75.2%, and 56.4% for group 1; 86.2%, 76.9%, and 50.9% for group 2; 86.4%, 71.0%, and 43.7% for group 3; and 86.7%, 70.1%, and 50.9% for group 4 (P =.867). There was no significant difference in freedom from transplant coronary artery disease among the 4 groups (P =.474).


CONCLUSIONS
Prolonged donor ischemic time is not a risk factor for decreased long-term survival. Procurement of hearts with prolonged donor ischemic time is justified in the setting of an increasing recipient pool with a fixed donor population.
Morgan
Jeffrey A
JA
Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. Jm2240@columbia.edu
John
Ranjit
R
Weinberg
Alan D
AD
Kherani
Aftab R
AR
Colletti
Nicholas J
NJ
Vigilance
Deon W
DW
Cheema
Faisal H
FH
Bisleri
Gianluigi
G
Cosola
Thomas
T
Mancini
Donna M
DM
Oz
Mehmet C
MC
Edwards
Niloo M
NM
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D006801:Humans; D007511:Ischemia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards / Q000639:trends; D016896:Treatment Outcome