K. T. Carter3, S. Lirette4, A. Panos1, R. P. Cochran1, L. L. Creswell1, D. Baran2, H. Copeland1 2Sentara Healthcare,Norfolk, VA, USA 3University Of Mississippi,Surgery,Jackson, MS, USA 4University Of Mississippi,Data Science,Jackson, MS, USA 1University Of Mississippi,Cardiothoracic Surgery,Jackson, MS, USA
Introduction: Various solutions are used for donor heart preservation. While studies have compared one or two solutions, no study has directly compared outcomes between the most commonly used preservation solutions in a large cohort. We hypothesize that there is no difference among cardiac preservation solutions.
Methods: The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from May 2007-March 2014 for donor hearts. Of the 141,500 potential donors, 1,240 were excluded for multiorgan transplants and 94,427 went on to heart transplant. The preservation solutions noted in the database and analyzed included: saline, University of Wisconsin (UW), “cardioplegia”, Celsior, and Custodial. Collins solution was excluded from the study given its low usage (11 patients). The various solutions were compared against saline. The primary endpoints are recipient survival at 30 days, one year, and long-term. Logistic and Cox models were used to quantify survival endpoints.
Results: 17,452 patients had cardiac preservation solution data available. Saline was used as the final preservation solution in 3,087 patients (18%), UW in 7047 (40%), cardioplegia 1,893 (11%), Celsior in 4,337 (25%), and Custodial used in 1,088 (6%). Donor age ranged from 0 – 73 years (mean=27.7, median=26), 69% were male, and 2% were diabetic. Donor ejection fraction (EF) varied from 1 – 99 (mean=61.8, median=60) and ischemic time ranged from 0.18 – 12 hours (mean=3.09, median=3.03). Survival of recipients whose donor hearts were procured with saline was 2,946 (96%) at 30 day and 2,775 (90%) at one year, UW had 6,743 (96%) 30 day and 6,331 (90%) one year survival, cardioplegia had 1,795 (95%) 30 day and 1,668 (88%) one year survival, Celsior had 4,109 (95%) 30 day and 3,836 (89%) one year survival, and Custodial had 1,051 (97%) 30 day and 988 (91%) one year survival. Analysis of Cox models for long-term survival revealed no statistical differences when compare to saline for UW (p=0.192) nor Custodial (p=0.528). Cardioplegia (HR=1.16; p=0.016) and Celsior (HR=1.14; p=0.009) were found to have higher hazard of mortality than saline (Figure 1).
Conclusion: Celsior and cardioplegia solutions for cardiac preservation are associated with a higher mortality in heart transplant recipients, while UW and custodial solutions are equivocal to saline. Based on the UNOS database, UW and custodial solutions have improved outcome for heart transplant recipients.
