9: Impact of ischemia time on the outcomes of heart transplant

Purpose: The life extending benefit of transplant has been estimated to be substantial, an average 14.5 life-years (LY) compared to listed but not transplanted patients. Ischemia time (IT) limited the benefit of transplant but can be favorably modified by changing procurement practices or by development of new approaches to organ preservation. Methods and Materials: OPTN data as of September 11, 2006 was used. All patients listed as eligible to receive or receiving heart transplant since 2000 were studied. Post-transplant survival effects of IT were drawn from the 2005 ISHLT report. Transplant benefit was determined by differences in the multivariate adjusted survival experiences (survival curves) of transplant recipients compared to candidates near the top of the waiting list. Transplant hospitalization outcomes are as reported to OPTN. Results: A total benefit of 29,182LY was produced by the 2,016 heart transplants performed in the US 2004. We estimate this total benefit to be 2,874LY (9.8%) greater had all heart transplants been performed with one-hour of IT.Length of post-transplant hospitalization increased an average 1.4 days and inpatient death risk increased 27% for each hour increase of IT.