Impact of 10°C static cold storage on donor-age-related outcomes after adult heart transplantation

Results from a single-center retrospective study evaluating whether 10°C static cold storage (SCS; n = 135) mitigates the impact of increasing donor age on post-transplant outcomes in adult heart transplant recipients, compared with ice storage (n = 276), were published in the Journal of Thoracic and Cardiovascular Surgery by Williams et al. Patients were stratified by donor age (18–30 years, n = 179; 30–40 years, n = 137; >40 years, n = 95). The primary outcome of interest was severe primary graft dysfunction (PGD). 

Key data: When donor age was modeled as a continuous variable, 10°C SCS reduced the age-related increase in risk observed with ice storage for severe PGD (odds ratio [OR] per year, 0.91; 95% confidence interval [CI], 0.83–0.97; p = 0.02) and 90-day mortality (OR per year, 0.89; 95% CI, 0.81–0.97; p = 0.006). After balancing for baseline characteristics, 10°C SCS was associated with lower odds of severe PGD in donor age groups 30–40 years (OR, 0.15; 95% CI, 0.02–0.68; p = 0.03) and >40 years (OR, 0.20; 95% CI, 0.03–0.81; p = 0.04), but not donor group <30 years (OR, 0.91; 95% CI, 0.36–2.32; p = 0.23). In an exploratory post hoc analysis of donors aged >45 years, severe PGD was more frequent with ice storage vs 10°C SCS (8.7% vs 0%); these findings were not adjusted for multiplicity due to the small sample size. 

Key learning: 10°C SCS may attenuate the impact of increasing donor age on severe PGD and early mortality in heart transplant recipients, supporting further evaluation of temperature-controlled static preservation strategies to expand donor-heart utilization.