Outcomes Comparison of Commonly Used Heart Transplant Preservation Solutions During the Covid-19 Pandemic

PurposeOrthotopic heart transplantation (OHT) is a necessity for patients with end-stage heart disease. Despite advancements made in cardiac allograft preservation, there remains ambiguity as to which heart preservation solution provides improved outcomes - especially during a national healthcare flux. Many papers compare University of Wisconsin (UW) and Celsior (CS), the two most commonly used solutions in the USA, in abdominal organ transplants but few describe relative outcomes related to the adult heart. Here, we compare the two commonly used preservation solutions and hypothesize that UW shows superior postoperative patient outcomes.MethodsThe United Network for Organ Sharing (UNOS) database was retrospectively reviewed from 5/31/2020 to 5/31/2021 for adult OHT recipients. Primary stratification was by solution type with evaluation of only UW and CS preservation solutions. Primary endpoints were survival and length of stay. Secondary endpoints were acute graft rejection, intubation status, and use of ECMO, IABP, and inotropes.ResultsAfter exclusion criteria, a total of 2,388 adult OHT recipients were identified. 1,941 (81.3%) transplants utilized UW. Analysis of Cox regression models for survival revealed no significant difference between both solutions. Fisher's exact test showed decreased rates of inotrope use (p = 0.008) and acute rejection episodes (p = 0.002) for UW solution (Fig. 1). There was no statistical significance between UW and CS with length of stay, intubation status, and use of ECMO, IABP at 72-hrs post-transplant (Fig. 1).ConclusionEvaluation of the two most commonly used heart preservation solutions nationwide reveals that CS is non-inferior to UW with regards to patient survival, length of stay, and use of ECMO and IABP. However, UW shows significantly reduced acute graft rejection and use of inotropes. Orthotopic heart transplantation (OHT) is a necessity for patients with end-stage heart disease. Despite advancements made in cardiac allograft preservation, there remains ambiguity as to which heart preservation solution provides improved outcomes - especially during a national healthcare flux. Many papers compare University of Wisconsin (UW) and Celsior (CS), the two most commonly used solutions in the USA, in abdominal organ transplants but few describe relative outcomes related to the adult heart. Here, we compare the two commonly used preservation solutions and hypothesize that UW shows superior postoperative patient outcomes. The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from 5/31/2020 to 5/31/2021 for adult OHT recipients. Primary stratification was by solution type with evaluation of only UW and CS preservation solutions. Primary endpoints were survival and length of stay. Secondary endpoints were acute graft rejection, intubation status, and use of ECMO, IABP, and inotropes. After exclusion criteria, a total of 2,388 adult OHT recipients were identified. 1,941 (81.3%) transplants utilized UW. Analysis of Cox regression models for survival revealed no significant difference between both solutions. Fisher's exact test showed decreased rates of inotrope use (p = 0.008) and acute rejection episodes (p = 0.002) for UW solution (Fig. 1). There was no statistical significance between UW and CS with length of stay, intubation status, and use of ECMO, IABP at 72-hrs post-transplant (Fig. 1). Evaluation of the two most commonly used heart preservation solutions nationwide reveals that CS is non-inferior to UW with regards to patient survival, length of stay, and use of ECMO and IABP. However, UW shows significantly reduced acute graft rejection and use of inotropes.