# Heart Transplantation and Cold Ischemia: Towards Crossing the Border?

## TL;DR

This study examines the impact of cold ischemic time on 30-day mortality after heart transplantation and finds no significant difference between longer and shorter times.

## Contribution

The study provides new insights into the safety of extended cold ischemic times in heart transplantation.

## Key findings

- No significant association was found between cold ischemia > 4 hours and 30-day mortality (P = 0.835).
- 43% of patients with cold ischemia ≥ 4 hours died within 30 days, compared to 31% with < 4 hours.
- The results suggest potential for expanding donor pool with longer ischemic times.

## Abstract

Heart transplantation is a crucial therapeutic modality for patients with
advanced heart failure. For satisfactory results, acceptable ischemic times
are essential. This study aims to investigate the relationship between cold
ischemic time > 4 hours and mortality in the first month after heart
transplantation.

Retrospective and observational analysis of medical records of patients who
underwent heart transplantation between January 2019 and December 2023. The
inclusion criteria were patients who underwent heart transplantation using
the histidine-tryptophan-ketoglutarate preservation solution during organ
retrieval and immediately before organ implantation. Recipient variables,
etiology of heart failure, procedural variables, and 30-day mortality were
studied.

During the study period, 62 patients underwent heart transplantation. There
were a predominance of males (79%) and an average age of 51 years. Seven
patients had a cold ischemic time ≥ 4 hours, with three dying (43%)
before 30 days. Among the 55 patients with cold ischemic times < 4 hours,
17 died (31%) before 30 days. Statistical analysis using the chi-square test
revealed no statistically significant association between cold ischemia and
mortality in the first 30 days after transplantation (P = 0.835).

The study found no difference in 30-day mortality between patients who
underwent heart transplantation with cold ischemic times > 4 hours and
those with cold ischemic times < 4 hours. Thus, there may be new
strategies to increase the number of donors with a safe rebalance of the
relationship between the number of available allografts and patients on the
waiting list.