Cardiac allograft ischemic time. Relation to graft survival and cardiac function.

Organ donor scarcity has resulted in an increasing number of long-distance cardiac allograft procurements. The effect on short-term (90-day) survival and cardiac function was assessed in a consecutive series of 167 heart transplants performed between April 1981 and July 1988. During that time, total allograft ischemic time was more than 4 hours in 22% of cases and more than 5 hours in 7%. In 1988, total ischemic times have been more than 4 hours in 38% of cases. Ninety-day graft loss (any cause) was 11% for ischemic times 0-120 minutes, 27% for ischemic times 121-240 minutes, 17% for ischemic times 241-300 minutes, and 0% for ischemic times greater than 300 minutes. In 107 patients who survived 3 months, cardiac function was assessed at 1 week by resting hemodynamics and at 3 months by treadmill testing (Bruce protocol), supine rest and exercise radionuclide angiography, and supine rest and exercise right-heart hemodynamics. Treadmill exercise duration was similar in the four groups of patients. Resting ejection fraction was also not different among the groups. Exercise ejection fraction did not rise in the group with ischemic times greater than 3 hours, but the difference did not achieve statistical significance. Resting right atrial pressure was not different among groups at 1 week and decreased significantly in all groups at 3 months. During supine exercise, right atrial pressure rose markedly in each group but was not different among groups.(ABSTRACT TRUNCATED AT 250 WORDS)