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Association of intraoperative oxygen debt with clinical outcomes after prolonged AWIT in DCD heart transplantation
Results from a retrospective, single-center study evaluating whether intraoperative oxygen extraction ratio (O₂ER) burden was associated with early clinical outcomes and modified risk among adult recipients of donation after circulatory death (DCD) hearts with prolonged asystolic warm ischemic time (AWIT), recovered using thoracoabdominal normothermic regional perfusion (TA-NRP), were published in the Journal of Heart and Lung Transplantation by Williams et al. Patients were stratified into four groups according to AWIT duration (short [<10 minutes] vs prolonged [≥10 minutes]) and time above 20% O₂ER (low [≤70 minutes] vs high [>70 minutes]): short AWIT/low O₂ER (n = 35), short AWIT/high O₂ER (n = 37), prolonged AWIT/low O₂ER (n = 22), and prolonged AWIT/high O₂ER (n = 18). The outcome of interest was a binary composite morbidity-mortality (M-M) outcome, a weighted score incorporating severe primary graft dysfunction (PGD), 90-day mortality, intensive care unit (ICU) length of stay (LOS) >15 days, and the need for renal replacement therapy. A score of >2 qualified patients as having M-M.
Key data: The cumulative M-M composite was more common in the prolonged AWIT/high O₂ER group (50%) compared with the short AWIT/low O₂ER (17.1%), short AWIT/high O₂ER (8.1%), and prolonged AWIT/low O₂ER (13.6%) groups (p = 0.004). The prolonged AWIT/high O₂ER group had the highest incidence of severe PGD (22.2%) compared with the short AWIT/low O₂ER (8.6%), short AWIT/high O₂ER, and prolonged AWIT/low O₂ER groups (0% each; p = 0.005); and highest 90-day mortality (22.2% vs 0%, 2.7%, 4.6%, respectively; p = 0.01). Among recipients with prolonged AWIT, maintaining the time spent above 20% O₂ER burden at ≤70 minutes was associated with lower odds of the composite M-M outcome (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.07–0.54; p = 0.003) compared with an O₂ER burden >70 minutes.
Key learning: Low O₂ER burden was associated with lower odds of post-transplant M-M among recipients of DCD heart allografts with prolonged AWIT, supporting further investigation of O₂ER-guided perfusion strategies in DCD transplantation protocols.
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