Date: Sunday, May 3, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:15pm-2:27pm
Location: Room 119-B
Objectives: To examine the effect of three commonly used preservation solutions on short- and long-term survival after orthotopic heart transplantation (OHT) using a large national database.
Methods: The United Network for Organ Sharing (UNOS) database was reviewed for all adult OHT recipients from 2004-2013. Patients were selected that received the same initial and final flush of the three solutions: University of Wisconsin (UW), Celsior (Ce), or Custodial (Cu). Risk-adjusted multivariable Cox proportional hazards regression analysis was used to examine 30-day, 1-year, 5-year, and 10-year survival. The Kaplan-Meier method was used to calculate survival.
Results: A total of 9198 patients were identified: UW 5040(54.8%), Ce 3496(38%), and Cu 662(7.2%). The donors were not different with respect to gender (UW: 75.1% vs. Ce: 75.5% vs. Cu: 76.4% male, p=0.71) or serum creatinine at the time of transplant (UW: 1.36 vs. Ce: 1.36 vs. Cu: 1.34 mg/dL, p=0.83). The donors were different in age (UW: 31 vs. Ce: 31.4 vs. Cu: 32.3 yrs, p=0.02). Transplant characteristics were similar in gender match (UW: 25.9% vs. Ce: 26.7% vs. Cu: 25.2%, p=0.627). They differed in ischemic time (UW: 3.30 vs. Ce: 3.21 vs. Cu: 3.05 hrs, p<0.0001). Post-operative outcomes were different in rates of acute rejection episodes on index hospitalization (UW: 12.3% vs. Ce: 22.7% vs. Cu: 13.3%, p<0.0001). Survival at 5-years differed between the groups (UW: 74.5% vs. Ce: 72.4% vs. Cu 80.1%, p=0.0057). Multivariate analysis showed Ce flush (in reference to UW) was associated with higher mortality at 30 days (HR: 1.33, 95% CI 1.07-1.65, p=0.0092), 5 years (HR 1.12, 95% CI 1.01-1.24, p=0.03), and 10 years (HR 1.13, 95% CI 1.02-1.25, p=0.02). Use of Cu (in reference to UW) was not associated with an increased mortality at any time. Other variables associated with mortality at 10 years included gender mismatch, prolonged ischemic time, increasing recipient creatinine, increasing donor age, and ECMO or mechanical ventilation as a bridge to transplantation.
Conclusions: UW or Cu should be favored over Ce as the preservation solutions of choice in OHT as there is a clear short- and long-term survival advantage.
To cite this abstract in AMA style:Lewis C, Jayarajan S, Taghavi S, Kadakia S, Ambur V, Shiose A, Wheatley G, Kaiser L, Guy T, Toyoda Y. Preservation Solution Impacts Short- and Long-Term Survival in Orthotopic Heart Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). http://atcmeetingabstracts.com/abstract/preservation-solution-impacts-short-and-long-term-survival-in-orthotopic-heart-transplant-recipients/. Accessed April 23, 2017.
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