Affiliation:
1. Department of Surgery Division of Cardiovascular Surgery Columbia University New York New York USA
2. Cleveland Clinic Heart Vascular and Thoracic Institute Weston Florida USA
3. Fulcrum Jackson Mississippi USA
4. Lutheran Hospital – Fort Wayne Indiana Department of Cardiovascular and Thoracic Surgery Heart Transplant, Mechanical Circulatory Support and ECMO Fort Wayne Indiana USA
5. Indiana University School of Medicine – Fort Wayne (IUSM‐FW) Fort Wayne Indiana USA
Abstract
AbstractIntroductionSome studies have shown increased incidence of Primary Graft Dysfunction (PGD) after heart and lung procurement for heart transplant recipients. There have been limited investigations of the impact of lung procurement on heart procurement and the potential effects of the exposure to the type of lung preservation solution, the volume of the lung preservation solution and adequacy of decompression of the heart during heart and lung procurement and the impact on heart transplant outcomes.MethodsAdult heart transplant recipients in the UNOS database recorded from January 1, 2000 to June 30, 2022 formed the study cohort. Any heart that was procured with a lung team that utilized Perfadex preservation solution (XVIVO, Gothenburg, Sweden) was classified as exposed to Perfadex and otherwise classified as not exposed to Perfadex. Lung procurements performed with a preservation solution other than Perfadex or unknown were excluded (n = 2486). Simple comparisons were made with t‐tests or chi‐squared tests. Logistic regression models were used to predict 30 day and 1 year survival. Accelerated failure time models were employed to analyze time to death and time to rejection.ResultsThe cohort consisted of 34 192 heart transplants, of which 21 928 donors were not exposed to Perfadex (64.1%). There were statistically, but not clinically, significant differences in donor characteristics for these groups including in donor age (33.34 ± 11.01 not exposed vs. 30.70 ± 10.69 exposed; p < .001), diabetic donor (4% not exposed vs. 3% exposed; p = .004), and ischemic time (3.28 ± 1.09 h not exposed vs. 3.24 ± 1.05 h exposed; p = .002). In adjusted models, for all included donors, Perfadex exposure was associated with increased short term mortality, but no long term difference (1 year mortality OR 1.10, p = .014).ConclusionPerfadex exposure was associated with increased short‐term mortality for heart transplant recipients. Mechanistic investigation is warranted.