Evaluating Transition From University of Wisconsin to Del Nido Cardioplegia for Cardiac Allograft Preservation: The Vanderbilt Experience

The University of Wisconsin (UW) solution is widely used for cardiac allograft preservation. In early 2021, our center transitioned to Del Nido (DN) cardioplegia for all donors. This study evaluated whether this shift affected post-transplant outcomes. Adult, single-organ, donation after brain death heart transplants from January 2020 to December 2023 were included; congenital cases and non-ice storage techniques were excluded. Recipients were grouped by preservation solution. Interrupted time series (ITS) regression accounted for temporal bias and baseline differences, while exponential decay analysis evaluated lactate clearance. Of 203 transplants, 71 used UW and 132 used DN. Baseline characteristics were similar aside from longer ischemic times in the DN group. Unadjusted outcomes showed no significant differences in severe primary graft dysfunction (PGD), early mortality, cardiac index, or 24 hour vasoactive inotrope score (VIS). Intensive care unit and hospital stays were longer in the DN group. Lactate clearance was faster with DN (half-life 11.3 vs. 18.6 hours; p = 0.07). Interrupted time series regression showed no significant impact of DN on PGD, mortality, or morbidity scores, though VIS modestly increased (p = 0.048), and peak lactate levels decreased (p = 0.004). Del Nido provides comparable preservation to UW, supporting its use based on logistics and availability.