Cold ischemic time and early vasoactive-inotropic support following heart transplantation with HTK-preserved donor hearts

Whether longer cold ischemic time (CIT) increases early hemodynamic support after heart transplantation (HTx) with histidine-tryptophan-ketoglutarate (HTK) preservation is unclear. We examined the association between CIT and the vasoactive-inotropic score (VIS), a marker of circulatory support. We studied consecutive adults transplanted with HTK-preserved grafts at Lausanne University Hospital (January 2016-March 2025). VIS was calculated hourly for 48 h after ICU admission, and its association with CIT modeled using restricted cubic splines. Among 130 recipients (75% male, aged 52±12 years), mean CIT was 152±50 min. Longer CIT was associated with higher 24-hour VIS (Poverall=0.048), rising steeply beyond ≈200 min. Patients with CIT ≥200 min (n=14) had higher VIS (difference at 48 h 10.2 points, p=0.024), more post-transplant ECMO (43% vs 9%, p<0.001), and longer ICU stay (11.0 vs 6.1 days, p=0.014). The CIT-VIS relationship was non-linear, supporting CIT as a potentially modifiable determinant of early hemodynamic status after HTx.