Ex Vivo Heart Perfusion Offsets Ischemic Penalties With ≥6-Hour Preservation in Adult Donation-After-Brain-Death Heart Transplantation

This retrospective analysis of the UNOS registry investigated patients after the latest allocation revision and examined whether ex vivo heart perfusion (EVHP) mitigated ischemic penalties in adult donation-after-brain-death heart transplants with preservation times of six hours or more. Among 546 recipients who met the criteria (320 receiving EVHP and 226 undergoing static/hypothermic storage), EVHP was associated with superior one-year survival (92.5 percent vs 86.3 percent, p=0.029) and three-year survival (90.9 percent vs 79.6 percent, p<0.001). Multivariable Cox regression confirmed that EVHP reduced the risk of mortality (HR 1.90 for non-EVHP, 95 percent CI 1.08-3.35, p=0.027), with benefits concentrated at high-volume centers. Spline analyses demonstrated an increase in mortality with prolonged preservation in static storage, attenuated by EVHP. The authors conclude that EVHP offsets the survival penalty associated with ischemic times of six hours or more, potentially enabling safer long-distance procurement and broader donor utilization.