DOI: 10.1161/circheartfailure.126.014240 ISSN: 1941-3289

Donor Heart Preservation at 10 °C Outperforms 4–8 °C With Improved Early Graft Function in Adult Heart Transplantation: A Vanderbilt and Duke Multicenter Study

Aaron M. Williams, Brian Lima, Abigail Benkert, Awab Ahmad, Swaroop Bommareddi, John Trahanas, Chen Chia Wang, Kevin C. McGann, Mark Petrovic, Stephen Devries, Joshua Lowman, Sarah Casalinova, Samuel Kesseli, Divyam Goel, Alejandro Lobo, Gabriel Esmalian, Adam Devore, Jeffrey Keenan, Carmelo Milano, Kelly Schlendorf, Matthew Bacchetta, Ashish S. Shah, Jacob Schroder
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BACKGROUND:

Static cold storage of cardiac allografts at 4–8 °C or 10 °C has yielded promising heart transplant outcomes compared with ice storage. However, direct comparisons between these 2 preservation temperatures are lacking. This dual-center study is the first to compare adult heart transplant outcomes using allografts preserved at 10 °C versus 4–8 °C static cold storage.

METHODS:

All single-organ, donation-after-brain-death adult heart transplants performed at 2 high-volume centers between January 2020 and April 2025 were retrospectively analyzed. Multiorgan, adult congenital, and donation-after-circulatory-death cases were excluded. A 3:1 nearest-neighbor propensity score matching was applied using a standardized mean difference <20% to create balanced cohorts. Firth logistic regression and quantile regression were used to evaluate categorical and continuous outcomes in unmatched and matched cohorts.

RESULTS:

Among 365 recipients, 113 received allografts preserved at 10 °C and 252 at 4–8 °C. The 10 °C group had higher donor and recipient risk profiles, including older donors (37 [28–43] versus 31 [24–39] years; P =0.004), greater donor-recipient sex mismatch, and more frequent donor undersizing by predicted heart mass ratio. Recipients in this cohort were older and had more re-sternotomies and higher serum creatinine levels at transplant. Patients in the 4–8 °C group were more often listed as Status 2. After matching, 10 °C preservation was associated with less primary graft dysfunction (2 [2.9%] versus 19 [14.6%]; P =0.008), less left and right ventricular dysfunction, reduced new intraaortic balloon pump use, and improved 1-year survival (95.7% versus 86.2%; P =0.02). Other outcomes, including cardiac indices and posttransplant length of stay, were not significantly different between groups.

CONCLUSIONS:

Preservation of cardiac allografts at 10 °C may yield superior early graft function compared with 4–8 °C static cold storage. However, further prospective studies are required to delineate the optimal donor heart preservation temperature.

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