Impact of Controlled Hypothermic Preservation of Donor Hearts at 4-8°C on Late Post-Transplant Cardiac Allograft Vasculopathy

Document Type

Conference Proceeding

Publication Date

4-2025

Publication Title

Journal of Heart and Lung Transplantation

Abstract

Purpose: Cardiac allograft vasculopathy (CAV) is one of the most common late-term morbidities in heart transplant, affecting ~50% of heart transplant recipients by 10 years and represents a significant risk for late post-transplant mortality. Although CAV is considered an immune-mediated issue, severe primary graft dysfunction (PGD) has been shown to be associated with development of CAV. The use of a static controlled moderate hypothermic organ transport system (SCTS) has been shown to significantly reduce post-transplant severe PGD, therefore we sought to examine whether development of CAV is also impacted by use of the SCTS.

Methods: Data from 833 adults at 19 US centers transplanted between October 2016-July 2023 were analyzed in the GUARDIAN-Heart registry. CAV was assessed at one, 2 and 3 years per institution standard. Recipients in whom an assessment was not done, or not gradable, were excluded. The determination of CAV was typically performed using angiography with or without IVUS, and an assessment of grade CAV2 or greater using the ISHLT grading was considered as moderate/severe CAV. In centers where IVUS was performed a Stanford grade of III or greater was classified as moderate/severe. Continued follow-up will allow for a larger analysis cohort at the time of presentation.

Results: Out of 833 patients, 482 had complete CAV assessment at years 1-3: SCTS=214 vs ice cooler transport (ICE)=268. Patients’ age and comorbidities were similar, with the exception of significantly longer average ischemic time in the SCTS cohort (3.6 vs 3.2 hours, p< 0.001). The SCTS cohort had a numerically lower rate of moderate/severe CAV in years 1 and 2, and those differences reached significance at 3 years; 11.2% vs 20.1%, p=0.009. See Figure.

Conclusion: Utilization of the SCTS for organ preservation at a controlled 4-8°C is associated with significant reductions in CAV developing beyond one-year post-transplant. Continued study through longer follow-up is warranted to validate these findings.

Volume

44

Issue

4 Suppl

First Page

s48

Comments

International Society for Heart and Lung Transplantation (ISHLT) 45th Annual Meeting, April 27-30, 2025, Boston, MA

Last Page

s49

DOI

10.1016/j.healun.2025.02.104

ISSN

1053-2498

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