BACKGROUND The Organ Care System and Non-ischemic Heart Preservation methods have emerged as significant advancements in heart transplantation, designed to mitigate ischemic injury and extend preservation times. However, their high costs and logistical complexities necessitate strategic utilization. METHODS We evaluated data from 83,761 heart transplants registered in the International Society for Heart and Lung Transplantation registry from 1988 to 2018. Utilizing a Cox proportional hazards model, we explored the influence of donor age and ischemic time on transplant survival. A key innovation of our study is the development of a nomogram to predict post-transplant survival, incorporating both traditional and advanced statistical methods. RESULTS The median age of recipients was 52 years (22% female) and 33 years (31% female) for donors. Analysis revealed a median ischemic time of 3 hours and median survival of 11.5 years across the cohort. The nomogram showed a decline in survival probabilities with increasing donor age, notably from age 40 and more significantly with ischemic times >4 hours. Ischemic times ≥4 hours versus <2 hours were associated with hazard ratio (HR) of 1.2 (95% CI, 1.1-1.3) for donors aged 40-59, a disparity that escalated for donors aged ≥60 (HR: 2.0; 95% CI, 1.5-2.7). CONCLUSIONS This study highlights the importance of careful donor selection and indicates that certain groups, particularly older donors with prolonged ischemic times, might benefit from ex-vivo preservation techniques. The developed nomogram offers a practical tool for clinicians, enhancing decision-making by providing detailed insights into the relationship between donor age, ischemic time, and post-transplant mortality.

中文翻译：

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心脏移植中的供体年龄和缺血时间 - 对器官保存的影响。


背景器官护理系统和非缺血性心脏保存方法已成为心脏移植的重大进步，旨在减轻缺血性损伤并延长保存时间。然而，它们的高成本和物流复杂性需要战略性利用。方法 我们评估了 83,761 年至 1988 年在国际心肺移植学会登记处登记的 2018 例心脏移植的数据。利用 Cox 比例风险模型，我们探讨了供体年龄和缺血时间对移植存活率的影响。我们研究的一个关键创新是开发了一种列线图来预测移植后生存率，结合了传统和先进的统计方法。结果 供体受者的中位年龄为 52 岁 （22% 为女性） 和 33 岁 （31% 为女性）。分析显示，整个队列的中位缺血时间为 3 小时，中位生存期为 11.5 年。列线图显示，随着供体年龄的增加，生存概率下降，特别是从 40 岁开始，在缺血时间 >4 小时时更显着。对于 40-59 岁的供体，缺血时间 ≥4 小时与 <2 小时的风险比 （HR） 为 1.2 （95% CI，1.1-1.3） 相关，这一差异在 ≥60 岁的供体中升级 （HR： 2.0;95% CI，1.5-2.7）。结论 本研究强调了仔细选择供体的重要性，并表明某些群体，尤其是缺血时间较长的老年供体，可能会受益于离体保存技术。开发的列线图为临床医生提供了一个实用工具，通过提供对供体年龄、缺血时间和移植后死亡率之间关系的详细见解来增强决策能力。