Short-term outcomes comparing the use of hypothermic perfusion machine in heart transplantation : a monocentric study

Short-term outcomes comparing the use of hypothermic perfusion machine in heart transplantation : a monocentric study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Short-term outcomes comparing the use of hypothermic perfusion machine in heart transplantation : a monocentric study Narek MATIKIAN, Christian TYMOWSKI, Patrick NATAF, Julia CAUDRON, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7113443/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Heart transplantation outcomes critically depend on graft preservation quality and ischemic time. Hypothermic machine perfusion of donor hearts has emerged as a promising method to reduce ischemia-reperfusion injury and primary graft dysfunction (PGD). We report our single-center experience comparing short-term outcomes of hypothermic perfusion using the X-Vivo system versus standard static cold storage (CS). Methods This descriptive, comparative study analyzed patients enrolled in the European NIHP2019 randomized controlled trial at our center between November 2020 and May 2023. Twenty-six adult heart transplant recipients were included: 14 in the CS group and 12 in the X-Vivo group. The primary endpoint was the incidence of PGD, defined by the 2014 ISHLT criteria. Secondary endpoints included major adverse cardiovascular events, 30-day mortality, use of extracorporeal membrane oxygenation (ECMO), and ICU length of stay. Results Moderate-to-severe PGD occurred significantly less frequently in the X-Vivo group (33%) compared to CS (79%) (p=0.02). Thirty-day PGD-free survival was higher with X-Vivo (67% vs. 21%, p=0.022). Severe PGD incidence was also reduced (17% vs. 64%, p=0.014). Multivariate analysis confirmed a lower risk of moderate-to-severe PGD (OR 0.04; 95% CI 0.00–0.74; p=0.031) and severe PGD (OR 0.04; 95% CI 0.00–0.84; p=0.038) with X-Vivo. Secondary endpoints, including major adverse cardiovascular and transplant events, 30-day mortality (15% overall), and ECMO use, did not differ significantly. Cold ischemia time was slightly longer in the X-Vivo group (237 vs. 197 minutes), with a mean machine perfusion duration of 137 minutes. Conclusions In this single-center cohort, hypothermic continuous perfusion with the X-Vivo system was associated with a significant reduction in early primary graft dysfunction after heart transplantation without affecting short-term mortality. These findings support hypothermic machine perfusion as a valuable adjunct to standard preservation techniques. Larger, multicenter studies with extended follow-up are needed to confirm these benefits and define optimal clinical use. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction In 2024 in France, according to recent data from the Agence de la Biomédecine (ABM), more than 400 patients underwent heart transplantation, with an increasing number of patients on the waiting list [ 1 ]. Perioperative mortality remains high, reaching up to 18% according to some authors. Outcomes after heart transplantation in terms of survival are intrinsically linked to graft quality but also to cold ischemia time, which should be kept as short as possible (< 4 hours) to limit ischemia-reperfusion injury of the harvested organ [ 2 ]. Primary graft dysfunctions (PGD) critically impact short- and long-term postoperative morbidity and mortality in heart transplant recipients, with incidences ranging from 20% worldwide [ 1 ] according to recent literature reviews, to nearly 43% at the national level as reported in the latest 2024 ABM annual report. Inspired by the favorable results of preservation machines for other organs such as kidneys, liver, and lungs [ 4 ], new cardiac graft preservation machines have been developed. Although encouraging, their superiority over standard preservation techniques has yet to be definitively proven [ 5 , 6 ]. Our center was one of the two French sites participating in the NIHP2019 study [ 7 ], the first multicenter randomized controlled trial evaluating a deep hypothermic cardiac graft preservation machine with continuous perfusion of a preservation solution on a static heart (X-Vivo). The primary 30-day results demonstrated a significant reduction in primary graft dysfunctions in the X-Vivo group compared to the control group using standard preservation methods. We aimed to describe our experience and the outcomes of our patients included in the study, in order to assess the real benefit that this organ preservation machine could provide in a center performing more than twenty heart transplants per year. Materials and Methods This is a descriptive, comparative study of patients included in the NIHP2019 trial [ 7 ], a European multicenter, randomized, prospective controlled trial comparing two groups: the standard preservation (SP) group and the hypothermic continuous perfusion machine group (X-Vivo). Inclusion and exclusion criteria are detailed in the NIHP2019 study publication. Both donors and recipients had to be adults aged 18 to 70 years awaiting transplantation. Recipients were excluded if they had previous organ transplantation, congenital heart disease, renal failure, or were on temporary circulatory support (ECLS or intra-aortic balloon pump). Donors with sternotomy redux or those deceased from traumatic causes were also excluded. Our center’s investigator handled patient inclusion after randomization. The primary endpoint was the occurrence of primary graft dysfunction (PGD), left or right, defined according to the 2014 ISHLT consensus criteria [ 8 ]. Secondary endpoints included the occurrence of major adverse cardiovascular events post-transplantation (MACTE) within 30 days, which encompassed PGD, acute rejection, new-onset ventricular arrhythmias, and cardiac arrest. Cardiac and non-cardiac deaths, acute renal failure requiring dialysis, length of ICU stay, operative times, and use of post-transplant mechanical circulatory support at 30 days were also studied. In the control group, cardioplegia and preservation solution consisted of a crystalloid solution (Custodiol, then Perisoc), delivered antegrade via the aortic root under pressure. The graft was transported in a standard cooler used for all our grafts. In the X-Vivo group, graft preparation procedures are detailed in the multicenter study. Cardioplegia was a specific crystalloid solution administered antegrade into the ascending aorta. Once harvested, the heart was placed on the machine, and the aortic root was continuously perfused with a mixture of the specific solution and recipient blood, prepared prior to departure. Continuous monitoring of graft pressure and temperature was performed during transport in the machine. Statistical Analysis Continuous variables were expressed as medians and interquartile ranges (IQR) and compared using the Mann-Whitney U test. Categorical variables were expressed as counts and percentages and compared using Fisher’s exact test or the chi-square test, as appropriate. Multivariate associations were calculated using binary logistic regression models. Variables with a two-sided nominal p-value < 0.1 in univariate analysis were included in the multivariate model. Final models were selected by backward stepwise variable selection based on Akaike’s Information Criterion (AIC), excluding significant variables showing collinearity. When several related variables were associated with the endpoint, only the most strongly associated variable was retained. Variables with variance inflation factors greater than 5 were excluded. All statistical analyses were performed using R software ( http://www.r-project.org/ ) and RStudio (© 2009–2020 RStudio, PBC). Figures were generated with the ‘ggplot2’ package and statistics with the ‘stats’ package. A p-value < 0.05 was considered statistically significant Results From November 2020 to May 2023, a total of 52 heart transplants were performed in our center. Among the 27 patients enrolled in the NIHP2019 trial, 26 were included in this analysis (one was excluded due to intraoperative death in the X-Vivo group). Fourteen patients (54%) were assigned to the standard cold storage (CS) group and 12 (46%) to the X-Vivo machine perfusion group. Donor characteristics were similar across groups. The mean donor age was 55 years, with 38% male donors and a mean BMI of 25 kg/m². Blood type distribution was as follows: 50% type A, 27% type O, 15% type B, and 8% type AB. Nearly half (46%) were smokers, and 23% had hypertension. Pre-procurement coronary angiography was performed in only 38% of cases. The majority had sinus rhythm (96%) mean LVEF was 61%, and 38% had recovered cardiac arrest. Recipient characteristics were also similar between groups. The mean age was 58 years, with a predominance of males (77%) and a mean BMI of 26 kg/m². Ischemic cardiomyopathy was the leading cause of end-stage heart failure (58%), followed by dilated cardiomyopathy (23%). Only two recipients (7.7%), both in the X-Vivo group, had undergone prior sternotomy. None were on long-term mechanical circulatory support. The median waitlist time was 34 days, with only 15% hospitalized at the time of graft allocation. Primary endpoint results demonstrated a significantly lower incidence of moderate-to-severe primary graft dysfunction (PGD) in the X-Vivo group (33%) compared to the CS group (79%) ( p = 0.02). The 30-day PGD-free survival was significantly higher with X-Vivo (67% vs. 21%, p = 0.022), with the majority of PGD events occurring within the first 24 hours post-transplant. Severe PGD was also less frequent in the X-Vivo group (17% vs. 64%, p = 0.014). However, right-sided PGD rates were not significantly different between groups (25% vs. 36%, p = 0.683). Multivariate analysis confirmed a lower risk of moderate to severe PGD (OR = 0.04, CI [0.00–0.74], p = 0.031) and severe PGD (OR = 0.04, CI [0.00–0.84], p = 0.038) in the X-Vivo group. Secondary outcomes did not show statistically significant differences between groups. While the composite incidence of major adverse cardiovascular and transplant events (MACTE) tended to be lower in the X-Vivo group (50% vs. 86%, p = 0.09), the adjusted analysis did not reach statistical significance (OR = 0.15, 95% CI [0.01–1.59], p = 0.115). Similarly, 30-day mortality was 15%, with two deaths in each group ( p > 0.999), and post-transplant ECMO use was comparable (42% vs. 64%, p = 0.249). No significant differences were observed in intraoperative parameters such as cardiopulmonary bypass duration (164 vs. 169 min), aortic cross-clamp time (85 vs. 80 min), or total operative time (320 vs. 306 min). Cold ischemia time was slightly longer in the X-Vivo group (237 vs. 197 min, p = 0.237), with a mean machine perfusion duration of 137 minutes. The incidence of acute kidney injury was 46% overall, with 38% requiring dialysis; again, no significant intergroup differences were found. The median ICU length of stay was 9 days in both groups ( p = 0.836). Discussion This single-center analysis from the NIHP2019 trial highlights the potential benefits of continuous hypothermic perfusion using the X-Vivo device in reducing the incidence of primary graft dysfunction (PGD) following heart transplantation. Our findings support and extend the results from the multicenter trial led by Rega et al., which demonstrated a significant reduction in PGD rates with X-Vivo preservation compared to static cold storage [ 7 ]. The observed reduction in both moderate-to-severe and severe PGD aligns with broader evidence from the literature identifying PGD as a leading cause of early post-transplant morbidity and mortality, with incidence rates ranging from 20% to over 40% depending on the cohort and definitions used [ 1 , 3 ]. In our study, the CS group exhibited a notably high PGD rate (79%), which could be attributed to the advanced donor age and limited use of pre-retrieval coronary imaging—both recognized risk factors for early graft failure [ 1 , 2 ]. It is well-established that prolonged ischemic time is a major determinant of graft injury, and that its impact is exacerbated in older donors [ 2 ]. Our mean cold ischemia time in the CS group remained below the 4-hour threshold considered critical in clinical practice. However, even within this window, hypothermic machine perfusion may confer additional protection by reducing ischemia-reperfusion injury, as suggested by the improved outcomes in the X-Vivo group [ 6 , 7 ]. The biological rationale for these findings lies in the ability of continuous hypothermic oxygenated perfusion to preserve myocardial metabolism, limit cellular edema, and reduce oxidative stress during transport—a concept already validated in other organs such as kidney, liver, and lung transplantation [ 4 ]. In contrast to normothermic perfusion approaches such as the Organ Care System (OCS), which allow longer preservation times but at higher logistical and economic costs [ 5 , 6 ], the X-Vivo system offers a simpler, more physiologically grounded alternative with favorable short-term outcomes. Nevertheless, our study has limitations inherent to its retrospective monocentric design and small sample size. Importantly, the strict selection criteria of the NIHP2019 trial, excluding patients with mechanical circulatory support or renal failure, limit the generalizability of our results to the broader transplant population. As highlighted by Guihaire et al., innovations in preservation must ultimately be evaluated in real-world scenarios to determine their true clinical value [ 1 ]. While we observed a trend toward reduced MACTE and ECMO use in the X-Vivo group, these secondary outcomes did not reach statistical significance. This may reflect insufficient power to detect such differences. Moreover, short-term mortality was not impacted, emphasizing the need for longer-term follow-up. The upcoming 1-year results of the NIHP2019 multicenter study may shed further light on the effects of this technology on survival and graft function [ 7 ]. Future research should also explore the economic implications and logistical feasibility of implementing hypothermic perfusion machines on a broader scale. In particular, their potential to expand the donor pool—by enabling the use of marginal donors, longer ischemia times, or even donation after circulatory death—could mark a paradigm shift in heart transplantation, similar to what has been achieved in other solid organ fields [ 1 , 4 ]. Conclusion In this single-center cohort derived from the NIHP2019 randomized trial, continuous hypothermic perfusion using the X-Vivo system was associated with a significant reduction in moderate-to-severe primary graft dysfunction, without impacting 30-day mortality. These findings support the growing body of evidence favoring ex vivo perfusion techniques in improving short-term graft function and patient safety following heart transplantation. While our data are limited by sample size and patient selection, they reinforce the potential of hypothermic machine perfusion as a valuable adjunct to standard preservation methods—particularly in settings involving higher-risk donors or marginal grafts. As observed in other organ transplant domains, the integration of advanced preservation strategies may contribute not only to improved early outcomes but also to expanding the donor pool. Larger, multicenter studies with longer-term follow-up are now warranted to validate these benefits, assess cost-effectiveness, and determine the optimal clinical scenarios in which this technology should be implemented in cardiac transplantation practice. Declarations Conflict of Interest None Ethics approval and consent to participate The study was approved by the Comité de Protection des Personnes (CPP) Nord Ouest IV (approval number: 20.00945.254048; EudraCT/ID-RCB: 2019-A01955-52). Written informed consent was obtained from all patients (or their legal representatives) included in this study. Consent for publication Not applicable. Clinical trial registration ClinicalTrials.gov Identifier: NCT03991923. Registration date: June 20, 2019. Funding None. Author Contribution Narek Matikian designed the study, drafted the manuscript and participated in the surgical proceduresChristian de Tymowski contributed to manuscript writing, performed the statistical analysis, and critically revised the manuscriptMarylou Para co-designed the study, collected the data, was involved in the follow-up of heart transplant recipients, participated in surgical procedures, and critically revised the manuscriptJulia Caudron and Pauline Issaurat contributed to data collection and patient follow-up of heart transplant recipients. Wael Braham participated in the surgical procedures and critically revised the manuscriptPatrick Nataf supervised the study and critically revised the manuscript.All authors read and approved the final version of the manuscript. Data Availability The datasets generated and/or analyzed during the current study are included in this published article and its supplementary information files. References Guihaire J, Guimbretière G, Lebreton G, Allain G, David CH, Pozzi M et al. Innovative approaches to organ preservation in heart transplantation: A comprehensive review by the French Society of Thoracic and Cardiovascular Surgery. Arch Cardiovasc Dis avr 2025;S1875213625002153. John MM, Shih W, Estevez D, Martens TP, Bailey LL, Razzouk AJ, et al. Interaction Between Ischemic Time and Donor Age on Adult Heart Transplant Outcomes in the Modern Era. Ann Thorac Surg sept. 2019;108(3):744–8. Buchan TA, Moayedi Y, Truby LK, Guyatt G, Posada JD, Ross HJ, et al. Incidence and impact of primary graft dysfunction in adult heart transplant recipients: A systematic review and meta-analysis. J Heart Lung Transpl juill. 2021;40(7):642–51. Iske J, Hinze CA, Salman J, Haverich A, Tullius SG, Ius F. The potential of ex vivo lung perfusion on improving organ quality and ameliorating ischemia reperfusion injury. Am J Transpl déc. 2021;21(12):3831–9. Ardehali A, Esmailian F, Deng M, Soltesz E, Hsich E, Naka Y, et al. Ex-vivo perfusion of donor hearts for human heart transplantation (PROCEED II): a prospective, open-label, multicentre, randomised non-inferiority trial. Lancet juin. 2015;385(9987):2577–84. Chan JL, Kobashigawa JA, Reich HJ, Ramzy D, Thottam MM, Yu Z, et al. Intermediate outcomes with ex-vivo allograft perfusion for heart transplantation. J Heart Lung Transpl mars. 2017;36(3):258–63. Rega F, Lebreton G, Para M, Michel S, Schramm R, Begot E, et al. Hypothermic oxygenated perfusion of the donor heart in heart transplantation: the short-term outcome from a randomised, controlled, open-label, multicentre clinical trial. Lancet août. 2024;404(10453):670–82. Weill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, et al. A consensus document for the selection of lung transplant candidates: 2014—An update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transpl janv. 2015;34(1):1–15. Tables Table 1 Characteristics of donors according to Xvivo Characteristic Overall, N = 26 (100%) 1 Cold storage, N = 14 (54%) 1 NIHP, N = 12 (46%) 1 p-value 2 Male Gender 10 (38) 5 (36) 5 (42) > 0.999 Age (y) 55 [48–62] 56 [53–60] 54 [47–63] 0.877 Height (cm) 169 [163–175] 168 [160–175] 169 [165–175] 0.641 Weight (kg) 72 [63–85] 73 [70–87] 71 [57–76] 0.246 BMI (kg/m 2 ) 25 [23–28] 27 [24–31] 23 [22–27] 0.136 A 13 (50) 8 (57) 5 (42) 0.431 B 4 (15) 3 (21) 1 (8.3) 0.598 AB 2 (8) 0 (0) 2 (17) 0.203 O 7 (27) 3 (21) 4 (33) 0.665 Smoking 12 (46) 8 (57) 4 (33) 0.225 Never smoking 14 (54) 6 (43) 8 (67) 0.225 Diabetes 1 (3.8) 0 (0) 1 (8.3) 0.462 Hypertension 6 (23) 3 (21) 3 (25) > 0.999 Ongoing inotropic support 23 (88) 12 (86) 11 (92) > 0.999 Total inotropic score 18 [9–51] 24 [14–45] 13 [5–60] 0.424 Noradrenaline dose 0 [0–1] 0 [0–0] 0 [0–1] 0.424 Coronary angiogram performed 10 (38) 5 (36) 5 (42) > 0.999 - No Coronary Stenosis 8 (80) 3 (60) 5 (100) - Non-Significant Stenosis 2 (20) 2 (40) 0 (0) Heart Rhythm > 0.999 Atrial Fibrillation 1 (3.8) 1 (7.1) 0 (0) Sinus Rhythm 25 (96) 13 (93) 12 (100) Normal AV Conduction 26 (100) 14 (100) 12 (100) Cardiac arrest and CPR 10 (38) 6 (43) 4 (33) 0.701 LVEF (%) 61 [60–65] 61 [58–65] 61 [60–65] 0.774 CMV 15 (58) 8 (57) 7 (58) 0.951 1 n (%); Median [Q1-Q3] 2 Fisher’s exact test; Wilcoxon rank sum test; Pearson’s Chi-squared test AV = Atrioventricular, BMI = Body Mass Index (kg/m 2 ), CMV = Cytomegalovirus, CPR = Cardio Pulmonary Resuscitation, LVEF = Left Ventricle Ejection Flow Table 2 Characteristics of recipient according to Xvivo Characteristic Overall, N = 26 (100%) 1 Cold storage, N = 14 (54%) 1 NIHP, N = 12 (46%) 1 p-value 2 Male Gender 20 (77) 10 (71) 10 (83) 0.652 Age (y) 58 [47–62] 58 [56–64] 53 [44–61] 0.257 Height (cm) 171 [165–178] 173 [165–178] 169 [165–177] 0.625 Weight (kg) 76 [64–91] 78 [66–87] 70 [63–95] 0.979 BMI (kg/m 2 ) 26 [23–29] 26 [21–31] 26 [23–28] 0.837 Blood type 0.720 A 12 (46) 7 (50) 5 (42) 0.671 B 4 (15) 3 (21) 1 (8.3) 0.598 AB 3 (12) 1 (7.1) 2 (17) 0.580 O 7 (27) 3 (21) 4 (33) 0.665 Active Smoker 3 (12) 1 (7.1) 2 (17) 0.580 Former Smoker 11 (42) 6 (43) 5 (42) 0.951 Never Smoker 12 (46) 7 (50) 5 (42) 0.671 Diabetes 8 (31) 4 (29) 4 (33) > 0.999 Hypertension 8 (31) 4 (29) 4 (33) > 0.999 Malignancy 2 (7.7) 1 (7.1) 1 (8.3) > 0.999 Current hospitalization 4 (15) 2 (14) 2 (17) > 0.999 Time on waiting list (days) 34 [12–297] 28 [15–275] 42 [11–653] 0.520 Immunosuppressive treatment 1 (3.8) 0 (0) 1 (8.3) 0.462 Indication : - Ischemic 15 (58) 8 (57) 7 (58) 0.951 - Dilated 6 (23) 4 (29) 2 (17) 0.652 - Other 5 (19) 2 (14) 3 (25) 0.635 Previous sternotomy 2 (7.7) 0 (0) 2 (17) 0.203 Patient on VAD 0 (0) 0 (0) 0 (0) Inotropic support 1 (3.8) 0 (0) 1 (8.3) 0.462 TPG 7 [4–10] 6 [4–9] 9 [7–10] 0.186 VAD_postop 0 (0) 0 (0) 0 (0) CMV 22 (85) 11 (79) 11 (92) 0.598 PHM.mismatch -8 [-19-1] -4 [-19-13] -12 [-17–3] 0.527 1 n (%); Median [Q1-Q3] 2 Fisher’s exact test; Wilcoxon rank sum test; Pearson’s Chi-squared test; Wilcoxon rank sum exact test BMI = Body Mass Index (kg/m 2 ), CMV = Cytomegalovirus, PHM = Predicted Heart Mass, PVR = Pulmonary valve Regurgitation, TPG = Trans Pulmonary Gradient, VAD = Ventricular Assist Device Table 3 Primary Endpoints and main secondary endpoints Characteristic Overall, N = 26 (100%) 1 Cold storage, N = 14 (54%) 1 NIHP, N = 12 (46%) 1 p-value 2 Primary Endpoints Moderate to severe PGD 15 (58) 11 (79) 4 (33) 0.020 Moderate PGD 4 (15) 2 (14) 2 (17) > 0.999 Severe PGD 11 (42) 9 (64) 2 (17) 0.014 Right ventricular PGD 8 (31) 5 (36) 3 (25) 0.683 Secondary Endpoints MACTE 18 (69) 12 (86) 6 (50) 0.090 ECLS 14 (54) 9 (64) 5 (42) 0.249 D30-mortality 4 (15) 2 (14) 2 (17) > 0.999 1 n (%); Median [Q1-Q3] 2 Fisher’s exact test; Wilcoxon rank sum test; Pearson’s Chi-squared test; Wilcoxon rank sum exact test ECLS = Extra Corporeal Life Support, MACTE = Major Adverse Cardiac Transplant Events, PGD = Primary Graft Dysfunction Table 4 Others Secondary Endpoints Characteristic Overall, N = 26 (100%) 1 Cold storage, N = 14 (54%) 1 NIHP, N = 12 (46%) 1 p-value 2 Donor heart transport time*(minutes) 230 [184–247] 197 [165–253] 237 [212–246] 0.237 Device perfusion time (minutes) 137 [98–159] NA [NA-NA] 137 [98–159] Duration of surgery (minutes) 314 [259–345] 306 [259–345] 320 [260–369] 0.820 Duration of cross-clamp (minutes) 82 [72–94] 80 [68–94] 85 [76–99] 0.396 Duration of ECC (minutes) 164 [133–188] 169 [143–193] 164 [120–180] 0.382 ECC wean time (minutes) 65 [47–89] 76 [62–102] 48 [26–71] 0.039 Cold Ischemic time 1 **(minutes) 24 [21–29] NA [NA-NA] 24 [21–29] Cold Ischemic time 2 ***(minutes) 67 [58–79] NA [NA-NA] 67 [58–79] Total inotropic score 41 [16–55] 47 [32–55] 27 [9–52] 0.110 Ventricular arrythmias 7 (27) 2 (14) 5 (42) 0.190 AKI 12 (46) 7 (50) 5 (42) 0.671 RRT 10 (38) 6 (43) 4 (33) 0.701 Time on RRT (days) 11 [4–30] 10 [4–30] 12 [5–23] > 0.999 Time on MV (hours) 60 [19–135] 61 [18–147] 53 [20–95] 0.666 Length.of.stay ICU (days) 9 [6–15] 9 [7–15] 10 [6–16] 0.836 1 n (%); Median [Q1-Q3] 2 Fisher’s exact test; Wilcoxon rank sum test; Pearson’s Chi-squared test; Wilcoxon rank sum exact test AKI = Acute Kidney Injury, ECC = Extra Corporeal Circulation, ICU = Intensive Care Unit, RRT = Renal Replacement Therapy, MV = Mechanical Ventilation * Time from Aortic clamping on donor to declamping on recipient ** Time from explantation to device starting with the heart *** Time from Device stop to declamping on recipient Table 5 Adjusted Odds Ratios for Total PGD_ Moderate to severe PGD Predictors Odds Ratios CI p (Intercept) 0.01 0.00–7.56 0.179 Blood Type A 6.31 0.40–98.66 0.189 Grouping NIHP 0.04 0.00–0.74 0.031 Duration of cross-clamp (minutes) 1.07 0.98–1.17 0.144 PHM.mismatch 1.02 0.95–1.09 0.560 Observations 26 R 2 Tjur 0.566 NIHP = Non-Ischeamic Heart Preservation (X-Vivo Group), PHM = Predicted Heart Mass Table 6 Adjusted Odds Ratios for severe PGD Severe PGD Predictors Odds Ratios CI p (Intercept) 0.04 0.00–3.41 0.156 Blood Type A 2.20 0.16–29.29 0.551 Grouping NIHP 0.04 0.00–0.84 0.038 Duration of cross-clamp (minutes) 1.05 0.99–1.11 0.128 PHM.mismatch 1.07 1.00–1.15 0.048 Observations 26 R 2 Tjur 0.508 NIHP = Non-Ischeamic Heart Preservation (X-Vivo Group), PHM = Predicted Heart Mass Table 7 Adjusted Odds Ratios for MACTE MACTE Predictors Odds Ratios CI p (Intercept) 0.54 0.00–63.30 0.799 Blood type A 10.11 0.64–159.98 0.101 Grouping NIHP 0.15 0.01–1.59 0.115 Duration of cross-clamp 1.03 0.97–1.09 0.400 (minutes) PHM.mismatch 1.07 0.95–1.20 0.291 Observations 26 R 2 Tjur 0.484 NIHP = Non-Ischeamic Heart Preservation (X-Vivo Group), PHM = Predicted Heart Mass Additional Declarations No competing interests reported. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pauline","middleName":"","lastName":"ISSAURAT","suffix":""},{"id":512506108,"identity":"46c78cab-cde9-4f2e-a8cd-56cd17ff5dc7","order_by":5,"name":"Wael BRAHAM","email":"","orcid":"","institution":"Bichat-Claude Bernard Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wael","middleName":"","lastName":"BRAHAM","suffix":""},{"id":512506110,"identity":"37beb865-b7af-4e18-8ff8-5610fd10c519","order_by":6,"name":"Marylou PARA","email":"","orcid":"","institution":"Bichat-Claude Bernard Hospital","correspondingAuthor":false,"prefix":"","firstName":"Marylou","middleName":"","lastName":"PARA","suffix":""}],"badges":[],"createdAt":"2025-07-13 13:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7113443/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7113443/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91507114,"identity":"68592535-5b5a-4a11-9eb2-3e0674642c7b","added_by":"auto","created_at":"2025-09-17 08:29:57","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54579,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig1.jpeg.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7113443/v1/b75a96fb392aa4a0beabba0a.jpeg"},{"id":91505982,"identity":"b9517fd7-8fb2-4dbb-9ec1-c5f13bf23da4","added_by":"auto","created_at":"2025-09-17 08:21:57","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":367482,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7113443/v1/f77ecb87fb555e2d45e2bd7c.jpeg"},{"id":91505985,"identity":"7a86d692-b7ce-4ad1-a7c3-52699f7ab81e","added_by":"auto","created_at":"2025-09-17 08:21:57","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":349101,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7113443/v1/bb6cf8dbb0e09302c84f9ead.jpeg"},{"id":91507115,"identity":"19395268-c242-4456-a4a7-aae977993e42","added_by":"auto","created_at":"2025-09-17 08:29:57","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":366712,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7113443/v1/35f2a6bd054a0b5b8fa3ad84.jpeg"},{"id":91505984,"identity":"93c86869-3ceb-4643-bab6-1ee9be2df371","added_by":"auto","created_at":"2025-09-17 08:21:57","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":253357,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7113443/v1/c75b1e818437275522e82dbb.jpeg"},{"id":108605688,"identity":"3cd6d657-3345-442f-8801-5052530e336f","added_by":"auto","created_at":"2026-05-06 12:13:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1910470,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7113443/v1/43e3c6b8-4b93-4a33-9d9d-ec0cca977fdd.pdf"},{"id":91505976,"identity":"cde387d3-b089-48ee-96ae-7966591a74c0","added_by":"auto","created_at":"2025-09-17 08:21:57","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14968,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-7113443/v1/deed8f4f038fcd829fd27d6c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Short-term outcomes comparing the use of hypothermic perfusion machine in heart transplantation : a monocentric study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn 2024 in France, according to recent data from the Agence de la Biom\u0026eacute;decine (ABM), more than 400 patients underwent heart transplantation, with an increasing number of patients on the waiting list [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Perioperative mortality remains high, reaching up to 18% according to some authors.\u003c/p\u003e\u003cp\u003eOutcomes after heart transplantation in terms of survival are intrinsically linked to graft quality but also to cold ischemia time, which should be kept as short as possible (\u0026lt;\u0026thinsp;4 hours) to limit ischemia-reperfusion injury of the harvested organ [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrimary graft dysfunctions (PGD) critically impact short- and long-term postoperative morbidity and mortality in heart transplant recipients, with incidences ranging from 20% worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] according to recent literature reviews, to nearly 43% at the national level as reported in the latest 2024 ABM annual report.\u003c/p\u003e\u003cp\u003eInspired by the favorable results of preservation machines for other organs such as kidneys, liver, and lungs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], new cardiac graft preservation machines have been developed. Although encouraging, their superiority over standard preservation techniques has yet to be definitively proven [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur center was one of the two French sites participating in the NIHP2019 study [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], the first multicenter randomized controlled trial evaluating a deep hypothermic cardiac graft preservation machine with continuous perfusion of a preservation solution on a static heart (X-Vivo).\u003c/p\u003e\u003cp\u003eThe primary 30-day results demonstrated a significant reduction in primary graft dysfunctions in the X-Vivo group compared to the control group using standard preservation methods.\u003c/p\u003e\u003cp\u003eWe aimed to describe our experience and the outcomes of our patients included in the study, in order to assess the real benefit that this organ preservation machine could provide in a center performing more than twenty heart transplants per year.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis is a descriptive, comparative study of patients included in the NIHP2019 trial [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], a European multicenter, randomized, prospective controlled trial comparing two groups: the standard preservation (SP) group and the hypothermic continuous perfusion machine group (X-Vivo).\u003c/p\u003e\u003cp\u003eInclusion and exclusion criteria are detailed in the NIHP2019 study publication.\u003c/p\u003e\u003cp\u003eBoth donors and recipients had to be adults aged 18 to 70 years awaiting transplantation.\u003c/p\u003e\u003cp\u003eRecipients were excluded if they had previous organ transplantation, congenital heart disease, renal failure, or were on temporary circulatory support (ECLS or intra-aortic balloon pump).\u003c/p\u003e\u003cp\u003eDonors with sternotomy redux or those deceased from traumatic causes were also excluded.\u003c/p\u003e\u003cp\u003eOur center\u0026rsquo;s investigator handled patient inclusion after randomization.\u003c/p\u003e\u003cp\u003eThe primary endpoint was the occurrence of primary graft dysfunction (PGD), left or right, defined according to the 2014 ISHLT consensus criteria [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSecondary endpoints included the occurrence of major adverse cardiovascular events post-transplantation (MACTE) within 30 days, which encompassed PGD, acute rejection, new-onset ventricular arrhythmias, and cardiac arrest. Cardiac and non-cardiac deaths, acute renal failure requiring dialysis, length of ICU stay, operative times, and use of post-transplant mechanical circulatory support at 30 days were also studied.\u003c/p\u003e\u003cp\u003eIn the control group, cardioplegia and preservation solution consisted of a crystalloid solution (Custodiol, then Perisoc), delivered antegrade via the aortic root under pressure. The graft was transported in a standard cooler used for all our grafts.\u003c/p\u003e\u003cp\u003eIn the X-Vivo group, graft preparation procedures are detailed in the multicenter study. Cardioplegia was a specific crystalloid solution administered antegrade into the ascending aorta. Once harvested, the heart was placed on the machine, and the aortic root was continuously perfused with a mixture of the specific solution and recipient blood, prepared prior to departure. Continuous monitoring of graft pressure and temperature was performed during transport in the machine.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were expressed as medians and interquartile ranges (IQR) and compared using the Mann-Whitney U test. Categorical variables were expressed as counts and percentages and compared using Fisher\u0026rsquo;s exact test or the chi-square test, as appropriate.\u003c/p\u003e\u003cp\u003eMultivariate associations were calculated using binary logistic regression models. Variables with a two-sided nominal p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in univariate analysis were included in the multivariate model. Final models were selected by backward stepwise variable selection based on Akaike\u0026rsquo;s Information Criterion (AIC), excluding significant variables showing collinearity. When several related variables were associated with the endpoint, only the most strongly associated variable was retained. Variables with variance inflation factors greater than 5 were excluded.\u003c/p\u003e\u003cp\u003eAll statistical analyses were performed using R software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.r-project.org/\u003c/span\u003e\u003cspan address=\"http://www.r-project.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e and RStudio (\u0026copy; 2009\u0026ndash;2020 RStudio, PBC). Figures were generated with the \u0026lsquo;ggplot2\u0026rsquo; package and statistics with the \u0026lsquo;stats\u0026rsquo; package.\u003c/p\u003e\u003cp\u003eA p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFrom November 2020 to May 2023, a total of 52 heart transplants were performed in our center. Among the 27 patients enrolled in the NIHP2019 trial, 26 were included in this analysis (one was excluded due to intraoperative death in the X-Vivo group). Fourteen patients (54%) were assigned to the standard cold storage (CS) group and 12 (46%) to the X-Vivo machine perfusion group.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDonor characteristics\u003c/b\u003e were similar across groups. The mean donor age was 55 years, with 38% male donors and a mean BMI of 25 kg/m\u0026sup2;. Blood type distribution was as follows: 50% type A, 27% type O, 15% type B, and 8% type AB. Nearly half (46%) were smokers, and 23% had hypertension. Pre-procurement coronary angiography was performed in only 38% of cases. The majority had sinus rhythm (96%) mean LVEF was 61%, and 38% had recovered cardiac arrest.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecipient characteristics\u003c/b\u003e were also similar between groups. The mean age was 58 years, with a predominance of males (77%) and a mean BMI of 26 kg/m\u0026sup2;. Ischemic cardiomyopathy was the leading cause of end-stage heart failure (58%), followed by dilated cardiomyopathy (23%). Only two recipients (7.7%), both in the X-Vivo group, had undergone prior sternotomy. None were on long-term mechanical circulatory support. The median waitlist time was 34 days, with only 15% hospitalized at the time of graft allocation.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrimary endpoint results\u003c/b\u003e demonstrated a significantly lower incidence of moderate-to-severe primary graft dysfunction (PGD) in the X-Vivo group (33%) compared to the CS group (79%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). The 30-day PGD-free survival was significantly higher with X-Vivo (67% vs. 21%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.022), with the majority of PGD events occurring within the first 24 hours post-transplant. Severe PGD was also less frequent in the X-Vivo group (17% vs. 64%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014). However, right-sided PGD rates were not significantly different between groups (25% vs. 36%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.683).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultivariate analysis\u003c/b\u003e confirmed a lower risk of moderate to severe PGD (OR\u0026thinsp;=\u0026thinsp;0.04, CI [0.00\u0026ndash;0.74], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031) and severe PGD (OR\u0026thinsp;=\u0026thinsp;0.04, CI [0.00\u0026ndash;0.84], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.038) in the X-Vivo group.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSecondary outcomes\u003c/b\u003e did not show statistically significant differences between groups. While the composite incidence of major adverse cardiovascular and transplant events (MACTE) tended to be lower in the X-Vivo group (50% vs. 86%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.09), the adjusted analysis did not reach statistical significance (OR\u0026thinsp;=\u0026thinsp;0.15, 95% CI [0.01\u0026ndash;1.59], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.115). Similarly, 30-day mortality was 15%, with two deaths in each group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.999), and post-transplant ECMO use was comparable (42% vs. 64%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.249).\u003c/p\u003e\u003cp\u003eNo significant differences were observed in intraoperative parameters such as cardiopulmonary bypass duration (164 vs. 169 min), aortic cross-clamp time (85 vs. 80 min), or total operative time (320 vs. 306 min). Cold ischemia time was slightly longer in the X-Vivo group (237 vs. 197 min, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.237), with a mean machine perfusion duration of 137 minutes. The incidence of acute kidney injury was 46% overall, with 38% requiring dialysis; again, no significant intergroup differences were found. The median ICU length of stay was 9 days in both groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.836).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis single-center analysis from the NIHP2019 trial highlights the potential benefits of continuous hypothermic perfusion using the X-Vivo device in reducing the incidence of primary graft dysfunction (PGD) following heart transplantation. Our findings support and extend the results from the multicenter trial led by Rega et al., which demonstrated a significant reduction in PGD rates with X-Vivo preservation compared to static cold storage [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe observed reduction in both moderate-to-severe and severe PGD aligns with broader evidence from the literature identifying PGD as a leading cause of early post-transplant morbidity and mortality, with incidence rates ranging from 20% to over 40% depending on the cohort and definitions used [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In our study, the CS group exhibited a notably high PGD rate (79%), which could be attributed to the advanced donor age and limited use of pre-retrieval coronary imaging\u0026mdash;both recognized risk factors for early graft failure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt is well-established that prolonged ischemic time is a major determinant of graft injury, and that its impact is exacerbated in older donors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Our mean cold ischemia time in the CS group remained below the 4-hour threshold considered critical in clinical practice. However, even within this window, hypothermic machine perfusion may confer additional protection by reducing ischemia-reperfusion injury, as suggested by the improved outcomes in the X-Vivo group [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe biological rationale for these findings lies in the ability of continuous hypothermic oxygenated perfusion to preserve myocardial metabolism, limit cellular edema, and reduce oxidative stress during transport\u0026mdash;a concept already validated in other organs such as kidney, liver, and lung transplantation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In contrast to normothermic perfusion approaches such as the Organ Care System (OCS), which allow longer preservation times but at higher logistical and economic costs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], the X-Vivo system offers a simpler, more physiologically grounded alternative with favorable short-term outcomes.\u003c/p\u003e\u003cp\u003eNevertheless, our study has limitations inherent to its retrospective monocentric design and small sample size. Importantly, the strict selection criteria of the NIHP2019 trial, excluding patients with mechanical circulatory support or renal failure, limit the generalizability of our results to the broader transplant population. As highlighted by Guihaire et al., innovations in preservation must ultimately be evaluated in real-world scenarios to determine their true clinical value [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile we observed a trend toward reduced MACTE and ECMO use in the X-Vivo group, these secondary outcomes did not reach statistical significance. This may reflect insufficient power to detect such differences. Moreover, short-term mortality was not impacted, emphasizing the need for longer-term follow-up. The upcoming 1-year results of the NIHP2019 multicenter study may shed further light on the effects of this technology on survival and graft function [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFuture research should also explore the economic implications and logistical feasibility of implementing hypothermic perfusion machines on a broader scale. In particular, their potential to expand the donor pool\u0026mdash;by enabling the use of marginal donors, longer ischemia times, or even donation after circulatory death\u0026mdash;could mark a paradigm shift in heart transplantation, similar to what has been achieved in other solid organ fields [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this single-center cohort derived from the NIHP2019 randomized trial, continuous hypothermic perfusion using the X-Vivo system was associated with a significant reduction in moderate-to-severe primary graft dysfunction, without impacting 30-day mortality. These findings support the growing body of evidence favoring ex vivo perfusion techniques in improving short-term graft function and patient safety following heart transplantation.\u003c/p\u003e\u003cp\u003eWhile our data are limited by sample size and patient selection, they reinforce the potential of hypothermic machine perfusion as a valuable adjunct to standard preservation methods\u0026mdash;particularly in settings involving higher-risk donors or marginal grafts. As observed in other organ transplant domains, the integration of advanced preservation strategies may contribute not only to improved early outcomes but also to expanding the donor pool.\u003c/p\u003e\u003cp\u003eLarger, multicenter studies with longer-term follow-up are now warranted to validate these benefits, assess cost-effectiveness, and determine the optimal clinical scenarios in which this technology should be implemented in cardiac transplantation practice.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of Interest\u003c/h2\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/div\u003e\n\u003cp\u003eThe study was approved by the Comit\u0026eacute; de Protection des Personnes (CPP) Nord Ouest IV (approval number: 20.00945.254048; EudraCT/ID-RCB: 2019-A01955-52). Written informed consent was obtained from all patients (or their legal representatives) included in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eClinical trial registration\u003c/h2\u003e\n\u003cp\u003eClinicalTrials.gov Identifier: NCT03991923. Registration date: June 20, 2019.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eNarek Matikian designed the study, drafted the manuscript and participated in the surgical proceduresChristian de Tymowski contributed to manuscript writing, performed the statistical analysis, and critically revised the manuscriptMarylou Para co-designed the study, collected the data, was involved in the follow-up of heart transplant recipients, participated in surgical procedures, and critically revised the manuscriptJulia Caudron and Pauline Issaurat contributed to data collection and patient follow-up of heart transplant recipients. Wael Braham participated in the surgical procedures and critically revised the manuscriptPatrick Nataf supervised the study and critically revised the manuscript.All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are included in this published article and its supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGuihaire J, Guimbreti\u0026egrave;re G, Lebreton G, Allain G, David CH, Pozzi M et al. Innovative approaches to organ preservation in heart transplantation: A comprehensive review by the French Society of Thoracic and Cardiovascular Surgery. Arch Cardiovasc Dis avr 2025;S1875213625002153.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJohn MM, Shih W, Estevez D, Martens TP, Bailey LL, Razzouk AJ, et al. Interaction Between Ischemic Time and Donor Age on Adult Heart Transplant Outcomes in the Modern Era. Ann Thorac Surg sept. 2019;108(3):744\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuchan TA, Moayedi Y, Truby LK, Guyatt G, Posada JD, Ross HJ, et al. Incidence and impact of primary graft dysfunction in adult heart transplant recipients: A systematic review and meta-analysis. J Heart Lung Transpl juill. 2021;40(7):642\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIske J, Hinze CA, Salman J, Haverich A, Tullius SG, Ius F. The potential of ex vivo lung perfusion on improving organ quality and ameliorating ischemia reperfusion injury. Am J Transpl d\u0026eacute;c. 2021;21(12):3831\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArdehali A, Esmailian F, Deng M, Soltesz E, Hsich E, Naka Y, et al. Ex-vivo perfusion of donor hearts for human heart transplantation (PROCEED II): a prospective, open-label, multicentre, randomised non-inferiority trial. Lancet juin. 2015;385(9987):2577\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChan JL, Kobashigawa JA, Reich HJ, Ramzy D, Thottam MM, Yu Z, et al. Intermediate outcomes with ex-vivo allograft perfusion for heart transplantation. J Heart Lung Transpl mars. 2017;36(3):258\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRega F, Lebreton G, Para M, Michel S, Schramm R, Begot E, et al. Hypothermic oxygenated perfusion of the donor heart in heart transplantation: the short-term outcome from a randomised, controlled, open-label, multicentre clinical trial. Lancet ao\u0026ucirc;t. 2024;404(10453):670\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, et al. A consensus document for the selection of lung transplant candidates: 2014\u0026mdash;An update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transpl janv. 2015;34(1):1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":" \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCharacteristics of donors according to Xvivo\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCharacteristic\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOverall,\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;26 (100%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCold storage, N\u0026thinsp;=\u0026thinsp;14 (54%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNIHP,\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;12 (46%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ep-value\u003csup\u003e\u003cspan class=\"Italic\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMale Gender\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10 (38)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (36)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAge (y)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e55 [48\u0026ndash;62]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e56 [53\u0026ndash;60]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e54 [47\u0026ndash;63]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.877\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHeight (cm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e169 [163\u0026ndash;175]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e168 [160\u0026ndash;175]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e169 [165\u0026ndash;175]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.641\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWeight (kg)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e72 [63\u0026ndash;85]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e73 [70\u0026ndash;87]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e71 [57\u0026ndash;76]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.246\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25 [23\u0026ndash;28]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27 [24\u0026ndash;31]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e23 [22\u0026ndash;27]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.136\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eA\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e13 (50)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 (57)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.431\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eB\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (15)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (21)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (8.3)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.598\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAB\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (8)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (17)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.203\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eO\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 (27)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (21)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (33)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.665\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSmoking\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 (46)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 (57)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (33)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.225\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNever smoking\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14 (54)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6 (43)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 (67)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.225\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDiabetes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (3.8)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (8.3)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.462\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHypertension\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6 (23)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (21)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (25)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOngoing inotropic support\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e23 (88)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 (86)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11 (92)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTotal inotropic score\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e18 [9\u0026ndash;51]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e24 [14\u0026ndash;45]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e13 [5\u0026ndash;60]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.424\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNoradrenaline dose\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 [0\u0026ndash;1]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 [0\u0026ndash;0]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 [0\u0026ndash;1]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.424\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCoronary angiogram performed\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10 (38)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (36)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e- No Coronary Stenosis\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 (80)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (60)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (100)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e- Non-Significant Stenosis\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (20)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (40)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Underline\"\u003eHeart Rhythm\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAtrial Fibrillation\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (3.8)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (7.1)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSinus Rhythm\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25 (96)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e13 (93)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 (100)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNormal AV Conduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26 (100)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14 (100)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 (100)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCardiac arrest and CPR\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10 (38)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6 (43)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (33)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.701\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLVEF (%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e61 [60\u0026ndash;65]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e61 [58\u0026ndash;65]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e61 [60\u0026ndash;65]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.774\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCMV\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e15 (58)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 (57)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 (58)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.951\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u0026nbsp;n (%); Median [Q1-Q3]\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u0026nbsp;Fisher\u0026rsquo;s exact test; Wilcoxon rank sum test; Pearson\u0026rsquo;s Chi-squared test\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eAV\u0026thinsp;=\u0026thinsp;Atrioventricular, BMI\u0026thinsp;=\u0026thinsp;Body Mass Index (kg/m\u003csup\u003e2\u003c/sup\u003e), CMV\u0026thinsp;=\u0026thinsp;Cytomegalovirus, CPR\u0026thinsp;=\u0026thinsp;Cardio Pulmonary Resuscitation, LVEF\u0026thinsp;=\u0026thinsp;Left Ventricle Ejection Flow\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/h3\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCharacteristics of recipient according to Xvivo\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCharacteristic\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOverall, N\u0026thinsp;=\u0026thinsp;26 (100%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCold storage, N\u0026thinsp;=\u0026thinsp;14 (54%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNIHP, N\u0026thinsp;=\u0026thinsp;12 (46%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ep-value\u003csup\u003e\u003cspan class=\"Italic\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMale Gender\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e20 (77)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10 (71)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10 (83)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.652\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAge (y)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e58 [47\u0026ndash;62]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e58 [56\u0026ndash;64]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e53 [44\u0026ndash;61]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.257\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHeight (cm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e171 [165\u0026ndash;178]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e173 [165\u0026ndash;178]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e169 [165\u0026ndash;177]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.625\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWeight (kg)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e76 [64\u0026ndash;91]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e78 [66\u0026ndash;87]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e70 [63\u0026ndash;95]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.979\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26 [23\u0026ndash;29]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26 [21\u0026ndash;31]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26 [23\u0026ndash;28]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.837\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBlood type\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.720\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eA\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 (46)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 (50)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.671\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eB\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (15)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (21)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (8.3)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.598\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAB\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (12)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (7.1)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (17)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.580\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eO\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 (27)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (21)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (33)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.665\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eActive Smoker\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (12)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (7.1)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (17)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.580\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFormer Smoker\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6 (43)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.951\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNever Smoker\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 (46)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 (50)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.671\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDiabetes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 (31)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (29)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (33)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHypertension\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 (31)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (29)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (33)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMalignancy\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (7.7)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (7.1)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (8.3)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCurrent hospitalization\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (15)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (14)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (17)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTime on waiting list (days)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e34 [12\u0026ndash;297]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28 [15\u0026ndash;275]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e42 [11\u0026ndash;653]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.520\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eImmunosuppressive treatment\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (3.8)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (8.3)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.462\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Underline\"\u003eIndication\u003c/span\u003e :\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e- Ischemic\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e15 (58)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 (57)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 (58)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.951\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e- Dilated\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6 (23)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (29)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (17)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.652\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e- Other\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (19)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (14)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (25)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.635\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePrevious sternotomy\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (7.7)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (17)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.203\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePatient on VAD\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInotropic support\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (3.8)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (8.3)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.462\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTPG\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 [4\u0026ndash;10]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6 [4\u0026ndash;9]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9 [7\u0026ndash;10]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.186\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eVAD_postop\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCMV\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e22 (85)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11 (79)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11 (92)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.598\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePHM.mismatch\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-8 [-19-1]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-4 [-19-13]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-12 [-17\u0026ndash;3]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.527\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u0026nbsp;n (%); Median [Q1-Q3]\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u0026nbsp;Fisher\u0026rsquo;s exact test; Wilcoxon rank sum test; Pearson\u0026rsquo;s Chi-squared test; Wilcoxon rank sum exact test\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eBMI\u0026thinsp;=\u0026thinsp;Body Mass Index (kg/m\u003csup\u003e2\u003c/sup\u003e), CMV\u0026thinsp;=\u0026thinsp;Cytomegalovirus, PHM\u0026thinsp;=\u0026thinsp;Predicted Heart Mass, PVR\u0026thinsp;=\u0026thinsp;Pulmonary valve Regurgitation, TPG\u0026thinsp;=\u0026thinsp;Trans Pulmonary Gradient, VAD\u0026thinsp;=\u0026thinsp;Ventricular Assist Device\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePrimary Endpoints and main secondary endpoints\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCharacteristic\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOverall, N\u0026thinsp;=\u0026thinsp;26 (100%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCold storage, N\u0026thinsp;=\u0026thinsp;14 (54%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNIHP, N\u0026thinsp;=\u0026thinsp;12 (46%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ep-value\u003csup\u003e\u003cspan class=\"Italic\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePrimary Endpoints\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eModerate to severe PGD\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e15 (58)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11 (79)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (33)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.020\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eModerate PGD\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (15)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (14)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (17)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSevere PGD\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9 (64)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (17)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.014\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRight ventricular PGD\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 (31)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (36)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (25)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.683\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSecondary Endpoints\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMACTE\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e18 (69)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 (86)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6 (50)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.090\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eECLS\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14 (54)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9 (64)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.249\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eD30-mortality\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (15)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (14)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (17)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u0026nbsp;n (%); Median [Q1-Q3]\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u0026nbsp;Fisher\u0026rsquo;s exact test; Wilcoxon rank sum test; Pearson\u0026rsquo;s Chi-squared test; Wilcoxon rank sum exact test\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eECLS\u0026thinsp;=\u0026thinsp;Extra Corporeal Life Support, MACTE\u0026thinsp;=\u0026thinsp;Major Adverse Cardiac Transplant Events, PGD\u0026thinsp;=\u0026thinsp;Primary Graft Dysfunction\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOthers Secondary Endpoints\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCharacteristic\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOverall, N\u0026thinsp;=\u0026thinsp;26 (100%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCold storage, N\u0026thinsp;=\u0026thinsp;14 (54%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNIHP, N\u0026thinsp;=\u0026thinsp;12 (46%)\u003csup\u003e\u003cspan class=\"Italic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ep-value\u003csup\u003e\u003cspan class=\"Italic\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDonor heart transport time*(minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e230 [184\u0026ndash;247]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e197 [165\u0026ndash;253]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e237 [212\u0026ndash;246]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.237\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDevice perfusion time (minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e137 [98\u0026ndash;159]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNA [NA-NA]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e137 [98\u0026ndash;159]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDuration of surgery (minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e314 [259\u0026ndash;345]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e306 [259\u0026ndash;345]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e320 [260\u0026ndash;369]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.820\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDuration of cross-clamp (minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e82 [72\u0026ndash;94]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e80 [68\u0026ndash;94]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e85 [76\u0026ndash;99]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.396\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDuration of ECC (minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e164 [133\u0026ndash;188]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e169 [143\u0026ndash;193]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e164 [120\u0026ndash;180]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.382\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eECC wean time (minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e65 [47\u0026ndash;89]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e76 [62\u0026ndash;102]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e48 [26\u0026ndash;71]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.039\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCold Ischemic time 1 **(minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e24 [21\u0026ndash;29]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNA [NA-NA]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e24 [21\u0026ndash;29]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCold Ischemic time 2 ***(minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e67 [58\u0026ndash;79]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNA [NA-NA]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e67 [58\u0026ndash;79]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTotal inotropic score\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e41 [16\u0026ndash;55]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e47 [32\u0026ndash;55]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27 [9\u0026ndash;52]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.110\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eVentricular arrythmias\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 (27)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (14)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.190\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAKI\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 (46)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 (50)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (42)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.671\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRRT\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10 (38)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6 (43)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (33)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.701\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTime on RRT (days)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11 [4\u0026ndash;30]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10 [4\u0026ndash;30]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 [5\u0026ndash;23]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.999\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTime on MV (hours)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e60 [19\u0026ndash;135]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e61 [18\u0026ndash;147]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e53 [20\u0026ndash;95]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.666\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLength.of.stay ICU (days)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9 [6\u0026ndash;15]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9 [7\u0026ndash;15]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10 [6\u0026ndash;16]\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.836\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u0026nbsp;n (%); Median [Q1-Q3]\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u0026nbsp;Fisher\u0026rsquo;s exact test; Wilcoxon rank sum test; Pearson\u0026rsquo;s Chi-squared test; Wilcoxon rank sum exact test\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eAKI\u0026thinsp;=\u0026thinsp;Acute Kidney Injury, ECC\u0026thinsp;=\u0026thinsp;Extra Corporeal Circulation, ICU\u0026thinsp;=\u0026thinsp;Intensive Care Unit, RRT\u0026thinsp;=\u0026thinsp;Renal Replacement Therapy, MV\u0026thinsp;=\u0026thinsp;Mechanical Ventilation\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e* Time from Aortic clamping on donor to declamping on recipient\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e** Time from explantation to device starting with the heart\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e*** Time from Device stop to declamping on recipient\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAdjusted Odds Ratios for Total PGD_\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003eModerate to severe PGD\u003c/span\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003ePredictors\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOdds Ratios\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003eCI\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003ep\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e(Intercept)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.01\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.00\u0026ndash;7.56\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.179\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBlood Type A\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6.31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.40\u0026ndash;98.66\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.189\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGrouping NIHP\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.04\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.00\u0026ndash;0.74\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.031\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDuration of cross-clamp (minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.07\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.98\u0026ndash;1.17\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.144\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePHM.mismatch\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.02\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.95\u0026ndash;1.09\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.560\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eObservations\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eR\u003csup\u003e2\u003c/sup\u003e Tjur\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.566\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNIHP\u0026thinsp;=\u0026thinsp;Non-Ischeamic Heart Preservation (X-Vivo Group), PHM\u0026thinsp;=\u0026thinsp;Predicted Heart Mass\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAdjusted Odds Ratios for severe PGD\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSevere PGD\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003ePredictors\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOdds Ratios\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003eCI\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003ep\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e(Intercept)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.04\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.00\u0026ndash;3.41\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.156\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBlood Type A\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.20\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.16\u0026ndash;29.29\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.551\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGrouping NIHP\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.04\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.00\u0026ndash;0.84\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.038\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDuration of cross-clamp (minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.05\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.99\u0026ndash;1.11\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.128\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePHM.mismatch\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.07\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.00\u0026ndash;1.15\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.048\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eObservations\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eR\u003csup\u003e2\u003c/sup\u003e Tjur\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.508\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNIHP\u0026thinsp;=\u0026thinsp;Non-Ischeamic Heart Preservation (X-Vivo Group), PHM\u0026thinsp;=\u0026thinsp;Predicted Heart Mass\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAdjusted Odds Ratios for MACTE\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003eMACTE\u003c/span\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003ePredictors\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOdds Ratios\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003eCI\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003ep\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e(Intercept)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.54\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.00\u0026ndash;63.30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.799\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBlood type A\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10.11\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.64\u0026ndash;159.98\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.101\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGrouping NIHP\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.15\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.01\u0026ndash;1.59\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.115\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDuration of cross-clamp\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.03\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.97\u0026ndash;1.09\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.400\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e(minutes)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePHM.mismatch\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.07\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.95\u0026ndash;1.20\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.291\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eObservations\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eR\u003csup\u003e2\u003c/sup\u003e Tjur\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.484\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNIHP\u0026thinsp;=\u0026thinsp;Non-Ischeamic Heart Preservation (X-Vivo Group), PHM\u0026thinsp;=\u0026thinsp;Predicted Heart Mass\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7113443/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7113443/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003cbr\u003e\nHeart transplantation outcomes critically depend on graft preservation quality and ischemic time. Hypothermic machine perfusion of donor hearts has emerged as a promising method to reduce ischemia-reperfusion injury and primary graft dysfunction (PGD). We report our single-center experience comparing short-term outcomes of hypothermic perfusion using the X-Vivo system versus standard static cold storage (CS).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cbr\u003e\nThis descriptive, comparative study analyzed patients enrolled in the European NIHP2019 randomized controlled trial at our center between November 2020 and May 2023. Twenty-six adult heart transplant recipients were included: 14 in the CS group and 12 in the X-Vivo group. The primary endpoint was the incidence of PGD, defined by the 2014 ISHLT criteria. Secondary endpoints included major adverse cardiovascular events, 30-day mortality, use of extracorporeal membrane oxygenation (ECMO), and ICU length of stay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nModerate-to-severe PGD occurred significantly less frequently in the X-Vivo group (33%) compared to CS (79%) (p=0.02). Thirty-day PGD-free survival was higher with X-Vivo (67% vs. 21%, p=0.022). Severe PGD incidence was also reduced (17% vs. 64%, p=0.014). Multivariate analysis confirmed a lower risk of moderate-to-severe PGD (OR 0.04; 95% CI 0.00–0.74; p=0.031) and severe PGD (OR 0.04; 95% CI 0.00–0.84; p=0.038) with X-Vivo. Secondary endpoints, including major adverse cardiovascular and transplant events, 30-day mortality (15% overall), and ECMO use, did not differ significantly. Cold ischemia time was slightly longer in the X-Vivo group (237 vs. 197 minutes), with a mean machine perfusion duration of 137 minutes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003cbr\u003e\nIn this single-center cohort, hypothermic continuous perfusion with the X-Vivo system was associated with a significant reduction in early primary graft dysfunction after heart transplantation without affecting short-term mortality. These findings support hypothermic machine perfusion as a valuable adjunct to standard preservation techniques. Larger, multicenter studies with extended follow-up are needed to confirm these benefits and define optimal clinical use.\u003c/p\u003e","manuscriptTitle":"Short-term outcomes comparing the use of hypothermic perfusion machine in heart transplantation : a monocentric study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 08:21:52","doi":"10.21203/rs.3.rs-7113443/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"759b305d-a667-42f7-89ba-46364aca6e34","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-05-06T12:01:16+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T12:12:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 08:21:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7113443","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7113443","identity":"rs-7113443","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}