The influence of ischemia and reperfusion time on outcome in heart transplantation

Ischemia/reperfusion may lead to graft dysfunction in heart transplantation (HT). The purpose of this study was to evaluate the influence of ischemic and reperfusion time on acute cellular rejection (ACR) within the first-year post-HT and on long-term outcomes. Data were collected from 331 patients (mean age 49 ± 12 y, 28% females) who underwent HT 1988-2016. Endomyocardial biopsies obtained within the first year after HT were graded according to the 2004-ISHLT-WF. We classified the patients by ischemic time </≥4 hours and further by reperfusion time </≥90 minutes. Primary endpoint was ACR ≥ 2R within one-year post-HT. A multiple logistic regression analysis was used to adjust for potential confounders. Secondary endpoint was long-term survival. There were 56 (17%) patients who received donor hearts with ischemic time >4 hours, and of these, 31 (55%) patients had reperfusion with CPB ≥90 minutes. Ischemia >4 hours had an increased risk of ACR ≥ 2R during the first year (adjusted OR = 3.1, P =.016); however, an extended reperfusion ≥90 minutes reduced the risk (adjusted OR = 0.25, P =.024). The conditional probability of surviving 10 years post-transplant, given that the patients already survived first year, was inferior for recipients with ischemia ≥ 4 hours and reperfusion <90 minutes, 59%, compared with the other groups 83%, P =.016. Prolonged reperfusion appears to reduce the risk for ACR ≥ 2R and improve long-term survival.