Duration of graft cold ischemia in long-term follow-up of orthotopic heart transplantation

 Aim. To evaluate the effect of the duration of graft cold ischemia on the long-term prognosis of orthotopic heart transplantation (OHT).

Material and Methods. The study included 60 patients, who had receieved OHT in the Meshalkin National Medical Research Center since 2012. The influence of the duration of graft cold ischemia on the outcome of OHT in the long-term follow-up was evaluated. Survival, quality of life according to the SF-36 questionnaire, and parameters of cardiopulmonary exercise testing (CPET) were assessed.

Results. The duration of graft cold ischemia in the study group was 210 (175–340) minutes. The minimum duration time was 158 minutes; the maximum duration time was 430 minutes. Graft ischemia for more than 240 minutes was registered in 42% of cases. The survival rate was 87% in the long-term follow-up. Exercise capacity of patients corresponded to the level above average or high: peak oxygen consumption was 17 (14.7–21.0) mL/min/kg with a threshold load power of 100 (90–120) W. The levels of quality of life based on the SF-36 questionnaire scoring were 53 (50–55) points for the physical component of health and 52 (50–56) points for the psycho-emotional component of health. No significant associations of graft cold ischemia duration were found with the survival rate, quality of life, and CPET parameters.

Conclusion. The duration of graft cold ischemia did not show any negative effect on the results of OHT in the long-term followup. The study group of  recipients was characterized by high survival rate and high exercise capacity  in the long-term follow-up after OHT. 

1. Gautier S.V., Starodubov V.I., Gabbasova L.A., Homyakov S.M., Kucheryavay A.V., Minina M.G. National Transplant Registry: State and development prospects. Russian Journal of Transplantology and Artificial Organs. 2020;22(S):5–7 (In Russ.).

2. Gautier S.V. Innovations in transplantology: heart transplantation program development in Russian Federation. Circulation Pathology and Cardiac Surgery. 2017;21(3S):61–68 (In Russ.). DOI: 10.21688/1681-3472-2017-3s-61-68.

3. Chambers D.C., Yusen R.D., Cherikh W.S., Goldfarb S.B., Kucheryavaya A.Y., Khusch K. et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Lung and Heartlung Transplantation Report–2017; Focus Theme: Allograft ischemic time. J. Heart Lung Transpl. 2017;36(10):1047–1059. DOI: 10.1016/j.healun.2017.07.016.

4. Tenchurina E.A., Minina M.G. Organizational, medical and epidemiological prerequisites for reviewing donor criteria in heart transplantation. Russian Journal of Transplantology and Artificial Organs. 2020;22(3):43–52 (In Russ.). DOI: 10.15825/1995-1191-2020-3-43-52.

5. Russo M.J., Chen J.M., Sorabella R.A., Martens T.P., Garrido M., Davies R.R. et al. The effect of ischemic time on survival after heart transplantation varies by donor age: An analysis of the United Network for Organ Sharing database. J. Thorac. Cardiovasc. Surg. 2007;133(2):554–559. DOI: 10.1016/j.jtcvs.2006.09.019.

6. Fernandez J., Aranda J., Mabbot S., Weston M., Cintron G. Overseas procurement of donor hearts: Ischemic time effect on postoperative outcomes. Transplant. Proc. 2001;33(7–8):3803–3804. DOI: 10.1016/s0041-1345(01)02610-0.

7. Yellon D.M., Hausenloy D.J. Myocardial reperfusion injury. N. Engl. J. Med. 2007;357(11):1121–1135. DOI: 10.1056/nejmra071667.

8. Erasmus M., Neyrink A., Sabatino M., Potena L. Heart allograft preservation: An arduous journey from the donor to the recipient. Curr. Opin. Card. 2017;32(3):292–300. DOI: 10.1097/hco.0000000000000395.

9. Mitropoulos F.A., Odim J., Marelli D., Karandikar K., Gjertson D., Ardehali A. et al. Outcome of hearts with cold ischemic time greater than 300 minutes. A case-matched study. Eur. J. Cardiothorac. Surg. 2005;28(1):143–148. DOI: 10.1016/j.ejcts.2005.01.067.

10. Alsov S.A., Fomichev A.V., Doronin D.V., Shmyrev V.A., Osipov D.E., Chernyavskiy A.M. Heart transplantation with extremely extended cold ischemia time of the donor heart. Russian Journal of Transplantology and Artificial Organs. 2018;20(1):110–113 (In Russ.). DOI: 10.15825/1995-1191-2018-1-110-113.

11. Levett D.Z.H., Jack S., Swart M., Carlisle J., Wilson J., Snowden C. et al. Perioperative cardiopulmonary exercise testing (CPET): Consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. Br. J. Anaesth. 2018;120(3):484–500. DOI: 10.1016/j.bja.2017.10.020.

12. Currie M.E., Shudo Y., Woo Y.J. Successful outcome following orthotopic heart transplantation with a donor half way across the country. Transplant. Proc. 2018;50(10):4062–4063. DOI: 10.1016/j.transproceed.2018.09.014.

13. Marasco S.F., Esmore D.S., Richardson M., Bailey M., Negri J., Rowland M. et al. Prolonged cardiac allograft ischemic time – no impact on long-term survival but at what cost? Clinical Transplantation. 2007;21(3):321–329. DOI: 10.1111/j.1399-0012.2007.00644.x.

14. Guazzi M., Arena R., Halle M., Piepoli M.F., Myers J., Lavie C.J. 2016 Focused Update: Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2016;133(24):e694–e711. DOI: 10.1161/cir.0000000000000406.

15. Tsai W.J., Tsai H.Y., Kuo L.Y., Lin Y.S., Chen B.Y., Lin W.H. et al. VE/VCO2 slope and functional capacity in patients post-heart transplantation. Transplant. Proc. 2018;50(9):2733–2737. DOI: 10.1016/j.transproceed.2018.05.010.

16. Uithoven K., Smith J., Medina-Inojosa J., Squires R., Van Iterson E., Olson T. Clinical and rehabilitative predictors of peak oxygen uptake following cardiac transplantation. J. Clin. Med. 2019;8(1):119. DOI: 10.3390/jcm8010119.

17. Loginova I.Y., Kamenskaya O.V., Chernyavskiy A.M., Doronin D.V., Alsov S.A., Lomivorotov V.N. Dynamic of end-tidal carbon dioxide pressure during cardiopulmonary exercise testing before and after

18. heart transplantation. Russian Journal of Transplantology and Artificial Organs. 2019;21(2):16–22 (In Russ.). DOI: 10.15825/1995-1191-2019-2-16-22.

19. Yeen W., Polgar A., Guglin M., Downes K., Faber C., Roy A. et al. Outcomes of adult orthotopic heart transplantation with extended allograft ischemic time. Transplant. Proc. 2013;45(6):2399–2405. DOI: 10.1016/j.transproceed.2013.04.003.

20. Slegtenhorst B.R., Dor F.J., Elkhal A., Rodriguez H., Yang X., Edtinger K. et al. Mechanisms and consequences of injury and repair in older organ transplants. Transplantation. 2014;97(11):1091–1099. DOI: 10.1097/tp.0000000000000072.

21. Chew H.C., Macdonald P.S., Dhital K.K. The donor heart and organ perfusion technology. J. Thorac. Dis. 2019;11(S6):S938–S945. DOI: 10.21037/jtd.2019.02.59.