Understanding preservation time thresholds in the modern era of heart transplantation
Abstract A 4-h preservation time threshold for cardiac allografts is the current standard in heart transplantation, but novel technologies are proposed to decrease the morbidity associated with prolonged allograft storage. This study examined adult heart transplant recipients from 2000–2015 and 2020...
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Nature Portfolio
2025-04-01
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| Online Access: | https://doi.org/10.1038/s41598-025-96544-z |
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| author | Chen Chia Wang Jessica B. Briscoe Corbin E. Goerlich Rachael Quinn Daniel Ragheb Shivani Shirodkar Antonio Polanco Ahmet Kilic Kavita Sharma James Gammie Ashish S. Shah Chetan Pasrija |
| author_facet | Chen Chia Wang Jessica B. Briscoe Corbin E. Goerlich Rachael Quinn Daniel Ragheb Shivani Shirodkar Antonio Polanco Ahmet Kilic Kavita Sharma James Gammie Ashish S. Shah Chetan Pasrija |
| author_sort | Chen Chia Wang |
| collection | DOAJ |
| description | Abstract A 4-h preservation time threshold for cardiac allografts is the current standard in heart transplantation, but novel technologies are proposed to decrease the morbidity associated with prolonged allograft storage. This study examined adult heart transplant recipients from 2000–2015 and 2020–2023 in the United States, stratified into an early (2000–2015) and modern era (2020–2023), then into standard (≤ 4 h) and prolonged (≥ 5 h) preservation time groups within each era. This study reinforced the 4-h threshold in the early era, where prolonged preservation significantly increased one-year mortality (HR 1.60, 95% CI 1.36–1.90). However, this association was no longer significant in the modern era (HR 1.14, 95% CI 0.85–1.50). A sub-analysis showed that using machine perfusion devices for allograft storage was not associated with one-year mortality (HR 1.15, 95% CI 0.79–1.70). Spline analysis demonstrated possible inflection points between 4 and 5 h and 8–9 h in the modern era, and further analysis found that 5–8 h of preservation did not increase one-year mortality (HR 1.09, 95% CI 0.80–1.47) relative to the ≤ 4 h group. In conclusion, the association between cardiac allograft preservation duration and morbidity has decreased in the modern era. Today, a 4-h preservation duration threshold may be too restrictive. |
| format | Article |
| id | doaj-art-7d0d8218db85432fa7bc7a5ca0ebb7fc |
| institution | DOAJ |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Nature Portfolio |
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| spelling | doaj-art-7d0d8218db85432fa7bc7a5ca0ebb7fc2025-08-20T03:18:34ZengNature PortfolioScientific Reports2045-23222025-04-0115111010.1038/s41598-025-96544-zUnderstanding preservation time thresholds in the modern era of heart transplantationChen Chia Wang0Jessica B. Briscoe1Corbin E. Goerlich2Rachael Quinn3Daniel Ragheb4Shivani Shirodkar5Antonio Polanco6Ahmet Kilic7Kavita Sharma8James Gammie9Ashish S. Shah10Chetan Pasrija11Vanderbilt University School of MedicineDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of MedicineDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of MedicineDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of MedicineVanderbilt University School of MedicineDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of MedicineDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of MedicineDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of MedicineDivision of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of MedicineDivision of Cardiac Surgery, Department of Surgery, Vanderbilt University Medical CenterDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of MedicineAbstract A 4-h preservation time threshold for cardiac allografts is the current standard in heart transplantation, but novel technologies are proposed to decrease the morbidity associated with prolonged allograft storage. This study examined adult heart transplant recipients from 2000–2015 and 2020–2023 in the United States, stratified into an early (2000–2015) and modern era (2020–2023), then into standard (≤ 4 h) and prolonged (≥ 5 h) preservation time groups within each era. This study reinforced the 4-h threshold in the early era, where prolonged preservation significantly increased one-year mortality (HR 1.60, 95% CI 1.36–1.90). However, this association was no longer significant in the modern era (HR 1.14, 95% CI 0.85–1.50). A sub-analysis showed that using machine perfusion devices for allograft storage was not associated with one-year mortality (HR 1.15, 95% CI 0.79–1.70). Spline analysis demonstrated possible inflection points between 4 and 5 h and 8–9 h in the modern era, and further analysis found that 5–8 h of preservation did not increase one-year mortality (HR 1.09, 95% CI 0.80–1.47) relative to the ≤ 4 h group. In conclusion, the association between cardiac allograft preservation duration and morbidity has decreased in the modern era. Today, a 4-h preservation duration threshold may be too restrictive.https://doi.org/10.1038/s41598-025-96544-zHeart transplantDonor allocation policyOrgan preservationMachine perfusionStatic cold storageOne-year survival |
| spellingShingle | Chen Chia Wang Jessica B. Briscoe Corbin E. Goerlich Rachael Quinn Daniel Ragheb Shivani Shirodkar Antonio Polanco Ahmet Kilic Kavita Sharma James Gammie Ashish S. Shah Chetan Pasrija Understanding preservation time thresholds in the modern era of heart transplantation Scientific Reports Heart transplant Donor allocation policy Organ preservation Machine perfusion Static cold storage One-year survival |
| title | Understanding preservation time thresholds in the modern era of heart transplantation |
| title_full | Understanding preservation time thresholds in the modern era of heart transplantation |
| title_fullStr | Understanding preservation time thresholds in the modern era of heart transplantation |
| title_full_unstemmed | Understanding preservation time thresholds in the modern era of heart transplantation |
| title_short | Understanding preservation time thresholds in the modern era of heart transplantation |
| title_sort | understanding preservation time thresholds in the modern era of heart transplantation |
| topic | Heart transplant Donor allocation policy Organ preservation Machine perfusion Static cold storage One-year survival |
| url | https://doi.org/10.1038/s41598-025-96544-z |
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