Impact of AWIT on outcomes in DCD heart transplantation

Results from a retrospective, single-center study, evaluating the impact of warm ischemic time on outcomes in adult heart transplant recipients receiving donation after circulatory death (DCD) hearts recovered using thoracoabdominal normothermic regional perfusion (TA‑NRP; N = 143), were published in The Journal of Heart and Lung Transplantation by Williams et al. The primary outcome was 90‑day mortality, with severe primary graft dysfunction (PGD) and 1‑year mortality also assessed. 

Key data: Among the ischemic intervals, asystolic warm ischemic time (AWIT) showed the strongest association with mortality. An AWIT threshold of 10 minutes was identified as optimal for predicting early mortality. Recipients with AWIT ≥10 minutes had higher 90‑day mortality (10.6% vs 2.1%; p = 0.04) and 1‑year mortality (12.8% vs 3.1%; p = 0.05) compared with those with AWIT <10 minutes. In weighted analyses, AWIT ≥10 minutes independently increased the risk of 30‑day mortality (hazard ratio [HR], 8.87; 95% confidence interval [CI], 2.06–82.26; p = 0.04), 90‑day mortality (HR, 6.42; 95% CI, 1.93–31.91; p = 0.03), and severe PGD (odds ratio [OR], 2.99; 95% CI, 1.29–7.61; p = 0.01). 

Key learning: In DCD heart transplantation using TA‑NRP, an AWIT ≥10 minutes was associated with increased risk of early mortality and severe PGD, suggesting a clinically relevant threshold for risk stratification.