Shorter Cold Ischemic Time in Older Donors Post-Heart Transplant Appears to Be Protective

Objective We have observed that minimally invasive left ventricular assist device (LVAD) insertion leads to more facile re-entry and easier cardiac transplantation. We hypothesize minimally invasive LVAD implantation results in improved outcomes at the time of subsequent heart transplant. Methods All adults undergoing cardiac transplantation between October 2015 and March 2019 at our institution were retrospectively reviewed. Those bridged to transplantation with a HeartWare HVAD were identified and divided into 2 cohorts based upon the surgical approach: those who underwent HVAD placement by conventional sternotomy versus minimally invasive insertion via lateral thoracotomy and hemisternotomy (LTHS). Patient demographics, as well as perioperative transplant outcomes, including survival, length of stay (LOS), blood utilization, ischemic time, bypass time, and postoperative extracorporeal membrane oxygenation (ECMO) were compared between cohorts. Results Forty-two patients were bridged to heart transplant with a HVAD implanted via either sternotomy ( n = 22) or LTHS technique ( n = 20). Demographics were similar between groups. There was 1 predischarge death in the sternotomy group and none in the LTHS group. Body surface area, cardiopulmonary bypass time, ischemic time, ECMO utilization, and reoperation for bleeding were similar. Red blood cell units transfused were significantly lower in the LTHS cohort (3.0 [1.0-5.0] vs 6.0 [2.5-10.0] P = 0.046). The LTHS cohort had a significantly shorter hospital LOS (12.0 [11.0-28.0] vs 22.5 [15.7-41.7] P = 0.022) with a trend toward shorter intensive care unit LOS (6.0 [5.0-10.5] vs 11.0 [6.0-21.5] days P = 0.057). Conclusions Minimally invasive HVAD implantation improves outcomes at subsequent heart transplantation, resulting in shorter LOS and less red cell transfusion. Larger multi-institutional studies are necessary to validate these findings.

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Quantitative Assessment of Effect of Preanalytic Cold Ischemic Time on Protein Expression in Breast Cancer Tissues

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djs438 ◽

2012 ◽

Vol 104 (23) ◽

pp. 1815-1824 ◽

Cited By ~ 82

Author(s):

V. M. Neumeister ◽

V. Anagnostou ◽

S. Siddiqui ◽

A. M. England ◽

E. R. Zarrella ◽

...

Keyword(s):

Breast Cancer ◽

Protein Expression ◽

Quantitative Assessment ◽

Ischemic Time ◽

Cold Ischemic Time ◽

Cancer Tissues

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Abstract 12932: The ABO Blood Group of Donor Hearts Determine the Impact of Cold Preservation Duration on Heart Transplant Outcomes

Circulation ◽

10.1161/circ.142.suppl_3.12932 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Paul C TANG ◽

Jonathan W Haft ◽

IENGLAM LEI ◽

Zhong Wang ◽

Eugene Chen ◽

...

Keyword(s):

Heart Transplant ◽

Allograft Rejection ◽

Blood Type ◽

Graft Dysfunction ◽

Ischemic Time ◽

Cold Preservation ◽

Transplant Outcomes ◽

Chronic Allograft Rejection ◽

Propensity Matching ◽

The Impact

Background: Tolerance of donor hearts of different ABO blood types to allograft ischemic time has not been previously examined. Objectives: We determined the impact of allograft ischemic time on heart transplant outcomes with differing ABO donor organ types. Methods: We identified 32,454 heart transplants (2000-2016) from the United Network for Organ Sharing database. Continuous variables were analyzed with t-test and categorical variables were compared with Chi-squared test. Survival was determined using log-rank or Cox regression tests. Propensity matching adjusted for preoperative variables. Results: Comparing allograft ischemic times <4 hours (hr, n=6579) versus ≥4hr (n=25,875), the odds ratio (OR) for death at 15 years following prolonged allograft ischemic time (≥4hrs) for blood type O, A, B, and AB were 1.106 (P<0.001), 1.062 (P<0.001), 1.059 (P=0.062), 1.114 (P=0.221), respectively. Unadjusted data demonstrated higher mortality for transplantation of O versus non-O donor hearts for allograft ischemic times ≥4 hours (OR=1.164, P<0.001). Following propensity matching, O donor hearts continued to have worse survival if preserved for ≥4hrs (OR=1.137, P=0.008), but not if allograft ischemic time was <4hrs (OR=1.042, P=0.113). In a matched group with ≥4hrs of allograft ischemic time, patients receiving O donor organs were more likely to experience death from primary allograft dysfunction (2.5% vs 1.7%, P=0.052) and chronic allograft rejection (1.9% versus 1.1%, P=0.021). No difference in death from primary allograft graft dysfunction or chronic allograft rejection was seen with <4hr of allograft ischemic time (P>0.150). Conclusions: Compared with non-O hearts, transplantation with O donor hearts stored for ≥4hrs leads to worse survival, with higher rates of primary graft dysfunction and chronic rejection. Caution should be practiced when considering donor hearts with the O blood type when extended cold preservation times are anticipated.

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Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Canadian Urological Association Journal ◽

10.5489/cuaj.1372 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 137

Author(s):

Dong Soo Park ◽

Jin Ho Hwang ◽

Moon Hyung Kang ◽

Jong Jin Oh

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Perioperative Outcomes ◽

Renal Neoplasm ◽

Cold Ischemia ◽

Ischemic Time ◽

Open Partial Nephrectomy ◽

Cold Ischemic Time ◽

Nephrometry Score ◽

Estimated Blood Loss

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

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Kidney transplant outcomes after medical assistance in dying

Canadian Urological Association Journal ◽

10.5489/cuaj.7304 ◽

2021 ◽

Vol 16 (2) ◽

Author(s):

Patrick P. Luke ◽

Anton Skaro ◽

Alp Sener ◽

Ephraim Tang ◽

Max Levine ◽

...

Keyword(s):

Kidney Transplantation ◽

Large Scale ◽

Graft Function ◽

Delayed Graft Function ◽

Medical Assistance ◽

Ischemic Time ◽

Transplant Outcomes ◽

Medical Assistance In Dying ◽

Cold Ischemic Time ◽

The Mean

Introduction: After nearly four years of Canadian experience with medical assistance in dying (MAiD), the clinical volume of organ transplantation following MAiD remains low. This is the first Canadian report evaluating recipient outcomes from kidney transplantation following MAiD. Methods: This was a retrospective review of the first nine cases of kidney transplants following MAiD at a Canadian transplant center. Results: Nine patients underwent MAiD followed by kidney retrieval during the study period. Their diagnoses were largely neuromuscular diseases. The mean warm ischemic time was 20 minutes (standard deviation [SD] 7). The nine recipients had a mean age of 60 (SD 19.7). The mean cold ischemic time was 525 minutes (SD 126). Delayed graft function occurred in only one patient out of nine. The mean 30-day creatinine was 124 umol/L (SD 52) . The mean three-month creatinine was 115 umol/L (SD 29). Conclusions: We report nine cases of kidney transplantation following MAiD. The process minimized warm ischemia, resulting in low delayed graft function rates, and acceptable post-transplant outcomes. Further large-scale research is necessary to optimize processes and outcomes in this novel clinical pathway.

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Longer Ischemic Time is Associated with Increased Ventricular Stiffness as Measured by Pressure–Volume Loop Analysis in Pediatric Heart Transplant Recipients

Pediatric Cardiology ◽

10.1007/s00246-017-1758-7 ◽

2017 ◽

Vol 39 (2) ◽

pp. 324-328 ◽

Cited By ~ 2

Author(s):

Luke W. Schroeder ◽

Shahryar M. Chowdhury ◽

Ali L. Burnette ◽

Minoo N. Kavarana ◽

G. Hamilton Baker ◽

...

Keyword(s):

Heart Transplant ◽

Transplant Recipients ◽

Loop Analysis ◽

Ischemic Time ◽

Heart Transplant Recipients ◽

Pediatric Heart Transplant

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Repeat Biomarker Status in Breast Resection Specimens With Controlled Cold Ischemic Time

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz105 ◽

2019 ◽

Vol 152 (6) ◽

pp. 766-774

Author(s):

Ellen G East ◽

Emily Roberts ◽

Lili Zhao ◽

Julie M Jorns

Keyword(s):

Epidermal Growth Factor Receptor ◽

Growth Factor Receptor ◽

Clinicopathologic Features ◽

Meaningful Change ◽

Ischemic Time ◽

Cold Ischemic Time ◽

Triage Protocol ◽

Epidermal Growth ◽

American Society ◽

Malignant Diagnosis

Abstract Objectives Current College of American Pathologists/American Society of Clinical Oncology guidelines recommend cold ischemic time (CIT) of 1 hour or less for breast specimens to preserve biomarker expression, although some publications support an acceptable CIT of 4 hours or less. We retrospectively evaluated changes in estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) from biopsy to resection specimens that were triaged to optimize CIT. Methods We identified breast resection specimens collected after institutional implementation of a triage protocol. Clinicopathologic features were assessed. Results In total, 295 excisions had a prior malignant diagnosis, with CIT of 4 hours or less and repeat ER, PR, and/or HER2; 230 (78%) had CIT of 1 hour or less, and 65 (22%) had CIT of more than 1 hour but 4 hours or less. Categorical change was seen in 10 (17.9%) of 56 with repeated ER/PR and 38 (13.3%) of 285 with repeated HER2 (of which five [1.8%] had meaningful change). Conclusions When CIT is optimized, a meaningful change in biomarker expression is infrequent. This study supports that when specimens are appropriately triaged, CIT of 4 hours or less may be acceptable.

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