Donor Heart Preservation at 10°C After Thoracoabdominal Normothermic Regional Perfusion Lowers Rates of Severe Primary Graft Dysfunction and Improves Recipient Transplant Outcomes.

This study compares a novel static cold storage (SCS) method using 10°C preservation to conventional ice following thoracoabdominal normothermic regional perfusion (TA-NRP) in donation after circulatory death (DCD) heart transplantation. We retrospectively analyzed adult recipients at a single center from October 2020 to October 2024, excluding congenital and multi-organ transplants. A total of 147 recipients met inclusion criteria (Ice = 96; 10°C = 51). Donors in the 10°C group were older, had higher BMI, and were more often female. Their allografts experienced longer total and warm ischemic times. Inverse probability of treatment weighting (IPTW) was applied to balance baseline differences, and multivariable regression adjusted for warm ischemic time. After adjustment, 10°C preservation was associated with a significantly reduced risk of severe primary graft dysfunction, post-bypass severe right ventricular depression, lower vasoactive inotropic scores at 24 hours, decreased incidence of recipient renal replacement therapy, shorter intensive care unit length of stay, and reduced 6-month mortality. This represents the largest comparison of 10°C versus ice preservation following TA-NRP and suggests that 10°C may offer superior early post-transplant outcomes. These findings warrant further validation in larger, prospective, multicenter studies to confirm the observed benefits.