Impact of warm ischemia time on survival after heart transplantation.
BACKGROUND
There is little data available on the specific effects of warm ischemia time (WIT) as opposed to cold ischemia or storage time. With current research endeavors focusing on warm continuous perfusion, storage of donor hearts, and utilization of hearts from non-heart-beating donors, the impact of WIT on outcomes is increasingly relevant. The aim of this study was to analyze our results in cardiac transplantation with specific focus on the impact of WIT.


METHODS
A retrospective review of 206 patients who underwent orthotopic heart transplantation at our institution between June 2001 and November 2010 was performed. Donor, recipient, and operative factors were analyzed. The main outcome variables were all cause mortality, survival, and primary graft failure.


RESULTS
WIT of >80 minutes was associated with reduced survival compared with a shorter WIT of <60 minutes. Multivariate analysis showed increasing donor age to be the most significant variable associated with increased risk of mortality (hazard ratio 1.04; P = .004) per year of increasing donor age.


CONCLUSIONS
This study has demonstrated a reduced survival in heart transplant recipients with increased WIT. This finding may be of particular relevance to potential future heart transplantation using organs procured from non-heart-beating donors.
Cardiothoracic Surgery Unit, The Alfred Hospital, Monash University, Melbourne, Australia. s.marasco@alfred.org.au
S F
SF
Marasco
A
A
Kras
E
E
Schulberg
M
M
Vale
G A
GA
Lee
D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria; D052096:Warm Ischemia / Q000009:adverse effects / Q000401:mortality*; D055815:Young Adult