Does ex vivo perfusion lead to more or less intimal thickening in the first‐year post–heart transplantation?

Abstract

Background The Organ Care System (OCS), an ex vivo heart perfusion platform, represents an alternative to the current standard of cold organ storage that sustains the donor heart in a near‐physiologic state. Previous reports showed that this system had significantly shortened the cold ischemic time from standard cold storage (CS). However, the effect of reduced ischemic injury against the coronary vascular bed has not been examined by intravascular ultrasound (IVUS). Methods Between August 2011 and February 2013, heart transplant (HTx) candidates enrolled in the PROCEED 2 trial were randomized to either CS or OCS. IVUS was performed at 4‐6 weeks (baseline) and repeated 1 year after transplantation. The change in maximal intimal thickness (MIT) and other clinical outcomes were examined. Results Thirty‐nine patients were randomized and underwent HTx by OCS (n=16) or CS (n=18). Of these, 18 patients (OCS: n=5, CS: n=13) with paired IVUS were examined. There were no significant differences in the change of MIT and other clinical outcomes between the groups. Conclusion The incidence of cardiac allograft vasculopathy in donor hearts preserved with the OCS versus CS was similar. These results suggest that this ex vivo allograft perfusion system is a promising and valid platform for donor heart transportation.

Normothermic Ex Situ Heart Perfusion With the Organ Care System for Cardiac Transplantation: A Meta-analysis

“…The literature search resulted in 1706 unique records, where 107 articles remained for eligibility control, of which 12 studies met the inclusion criteria (9 DBD and 3 DCD; Figure 1). 16,17,[23][24][25][33][34][35][36][37][38][39] This resulted in a study population of 741 patients who underwent HTx, of which 260 (35.1%) were performed using the OCS and 481 (64.9%) using SCS. One study was an RCT, 8 were cohort studies, and 3 were (subgroup) follow-up studies from earlier cohorts (Table S1, SDC, http:// links.lww.com/TP/C426).…”

Machine Perfusion for Human Heart Preservation: A Systematic Review

“…However, the mean total out-of-body time was significantly longer in the OCS group than in the control group (324 vs. 195 min) ( 7 ). The other two randomized studies reported data from single institutional heart transplant candidates, previously enrolled in the PROCEED II study and subsequently followed for an additional one and 2 years ( 12 , 13 ). There were no significant differences between the OCS and SCS groups regarding changes in intimal thickness for the left main and left anterior descending coronary arteries ( 13 ).…”

“…The other two randomized studies reported data from single institutional heart transplant candidates, previously enrolled in the PROCEED II study and subsequently followed for an additional one and 2 years ( 12 , 13 ). There were no significant differences between the OCS and SCS groups regarding changes in intimal thickness for the left main and left anterior descending coronary arteries ( 13 ). Chan et al followed the recipient for 2 years and did not find any significant differences in patient survival, freedom from non-fatal major cardiac events, or cardiac allograft vasculopathy ( 12 ).…”

“…Ultimately, 40 studies were included in this review: 18 papers ( 6 , 7 , 9 - 24 ), 17 conference abstracts ( 5 , 25 – 40 ), and five ongoing clinical trials ( 41 - 45 ). Three studies reported multicenter data ( 7 , 25 , 40 ), and three were randomized controlled studies ( 7 , 12 , 13 ).…”

The Tell-Tale Heart. Machine Perfusion in Heart Transplantation

“…Interestingly, in OCS group 4 hearts were discarded because of an increasing lactate concentration and histological analysis revealed signs of infarction and contusion and severe unrecognized left ventricular hypertrophy 13 . Other singlecenter and retrospective studies [14][15][16][17][18][19][20] further reported graft ischemic time significantly shorter when grafts were preserved with NMP instead of being preserved with SCS, as reported in Table I. Therefore, the OCS could be an effective tool to ensure graft quality when the expected ischemic exceed the traditional threshold of 4 hours, favoring long-distance organ retrieval.…”