Does Preservation Strategy Modify Sex-Specific Risk of Severe Primary Graft Dysfunction After Heart Transplantation: A GUARDIAN-Heart Analysis

Document Type

Conference Proceeding

Publication Date

8-2025

Publication Title

American Journal of Transplantation

Abstract

Purpose: In the GUARDIAN-Heart registry, the use of simple, controlled moderate hypothermia with the SherpaPak Cardiac Transport System (CTS) was associated with improved survival and significantly lower rates of severe PGD and use of post-transplant mechanical circulatory support (MCS). The purpose of this study was to examine whether use of CTS had similar effects on clinical outcomes in both men and women. Methods: The GUARDIAN-Heart registry is the largest multicenter registry comparing methods of hypothermic storage, including the Paragonix SherpaPak Cardiac Transplant System (CTS) and conventional ice storage (ICE). For the current analysis, adult (>18 years) patients who underwent HT within the registry from October 2015 through July 2024 were included. Baseline characteristics and clinical outcomes were stratified by sex and preservation method. The primary outcome was primary graft dysfunction (PGD) as defined by the 2014 ISHLT consensus definitions. Severe right ventricular dysfunction (RVD) was defined as echocardiographic determination of RV function at 24 hours post-transplant. Results: 1394 (28% women) HT recipients were included. Among 389 women, 204 (52%) were in the CTS group while 185 (48%) were in the ICE group. Of 1005 men, 576 (57%) were in the CTS group and 429 (43%) were in the ice group. Overall, baseline characteristics were similar between women in the CTS group and women in the ice group, except for significantly longer ischemic times, longer procurement distance traveled, and significantly shorter waitlist times in the CTS group. Women-CTS had lower rates of severe PGD-LV as compared to the women-ICE group (7.8% vs 9.7%) although this did not meet statistical significance (p = 0.59). Rates of severe PGD-LV were significantly lower in men-CTS as compared to men-ICE (6.9% vs 10.7%, p = 0.04), despite significantly longer total ischemic times. Women-CTS experienced significantly lower rates of severe RVD compared to women-ICE group (4.0% vs 12.0%, p = 0.007). Rates of temporary MCS were similar across all groups as was LVEF at 24 hours, inotrope score at 24 hours and ICU length of stay. There was no difference in one-year unadjusted survival between the four groups (log rank p = 0.74). Conclusions: Utilization of CTS for organ preservation in women was associated with a significant reduction in rates of severe RVD. Lower rates of severe PGD-LV were seen in women with CTS but small sample size may have limited power to detect a significant difference. Future investigations are needed to understand mechanisms underlying these findings.

Volume

25

Issue

8 Suppl 1

First Page

S832

Comments

American Society of Transplantation World Transplant Congress, August 2-6, 2025, San Francisco, CA

Last Page

S832

ISSN

1600-6135

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