Evaluation of the Organ Care System in Heart Transplantation With an Adverse Donor/Recipient Profile

Sáez, Diana García; Zych, Bartłomiej; Sabashnikov, Anton; Bowles, Christopher; Robertis, Fabio De; Mohite, Prashant N.; Popov, Aron‐Frederik; Maunz, Olaf; Patil, Nikhil P.; Weymann, Alexander; Pitt, Timothy; McBrearty, Louise; Pates, Bradley; Hards, Rachel; Amrani, Mohamed; Bahrami, Toufan; Banner, Nicholas R.; Simon, Andrè

doi:10.1016/j.athoracsur.2014.06.098

Cited by 129 publications

(70 citation statements)

References 16 publications

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“…The Organ care system was developed as a mobile perfusion module to overcome the limitation and effects of cold ischemic preservation on donor heart as prolonged total cold ischemic time has been shown to be a risk factor for developing CAV, primary graft dysfunction and mortality,consequently limit the available donor pool. Previous studies had reported the clinical usefulness of OCS platform with significant short cold ischemic time compared with the standard CS methods …”

Section: Discussionmentioning

confidence: 99%

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

Sato

Azarbal

Cheng

et al. 2019

Clinical Transplantation

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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.

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Section: Discussionmentioning

confidence: 99%

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

Sato

Azarbal

Cheng

et al. 2019

Clinical Transplantation

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“…The TransMedics Organ Care System includes NMP devices for the heart, lung and, most recently, liver. These devices are transportable to donor hospitals and initial publications of the heart and lung devices confirm the feasibility of their use in the clinical environment . There are no published reports yet relating to the liver device in either experimental or clinical settings.…”

Section: Devices Currently In Clinical or Preclinical Testingmentioning

confidence: 94%

Normothermic liver preservation: a new paradigm?

2015

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Summary Despite increasing donor numbers, waiting lists and pre‐transplant mortality continue to grow in many countries. The number of donor organs suitable for liver transplantation is restricted by cold preservation and ischemia‐reperfusion injury (IRI). Transplantation of marginal donor organs has led to renewed interest in new techniques which have the potential to improve the quality of preservation, assess the quality of the organ and allow repair of the donor organ prior to transplantation. If successful, such techniques would not only improve the outcome of currently transplanted marginal livers, but also increase the donor pool. Experimental evidence suggests that preservation under near physiological conditions of temperature and oxygenation abrogates IRI. Normothermic perfusion maintains the organ in a physiological state, avoiding the depletion of cellular energy and the accumulation of waste products, which occurs with static cold storage. It enables viability assessment prior to transplantation thereby reducing the risk of transplanting inherently marginal organs. Here we review the use of normothermic machine perfusion as a means of organ preservation.

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“…Recent clinical studies of normothermic machine perfusion followed by transplantation into recipient. Authors Tenderich et al 44 McCurry et al 45 Ardehali et al 48 Garc ıa Saez et al 43 Koerner et al 49 Heart Title of paper…”

Section: Lungmentioning

confidence: 99%

“…Across multiple studies, outcomes including recipient mortality, primary graft dysfunction, and acute rejection were shown to be equivalent or decreased in the NMP group compared to the group receiving hearts preserved with SCS 43,48 (Table 2). Extended ex vivo preservation of hearts has not yet been demonstrated clinically, as most trials have reported median perfusion times of $4 h. Still, there appear to be potential benefits to replacing the traditional ischemic time with either hypothermic or normothermic MP.…”

Section: Heartmentioning

confidence: 99%

Bioengineering approaches to organ preservation ex vivo

Pinezich

Vunjak‐Novakovic

2019

Exp Biol Med (Maywood)

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The advent of successful solid organ transplantation is undoubtedly among the most significant medical achievements of the 20th century. Despite advances in the field of transplantation since its inception over 50 years ago, our approach to donor organ preservation outside of the body remains unchanged. Recently, attempts have been made to replace static cold storage with more sophisticated ex vivo machine perfusion. Rather than cooling the organ on ice to slow metabolic processes, machine perfusion aims to support normal metabolic function in a near-physiologic environment and to provide a platform on which the organ can be evaluated, preserved, and recovered. Ex vivo machine perfusion devices have demonstrated early success with respect to transplant outcomes in heart, lung, and liver, with perfusion times limited to several hours. The continued development of more advanced perfusion systems is likely to extend the duration of ex vivo organ support to days or even weeks, and enable recovery of initially unsuitable donor organs. In this review, we discuss recent clinical and pre-clinical studies, state-of-the-art organ preservation technologies, existing limitations, and a perspective on future developments.

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Evaluation of the Organ Care System in Heart Transplantation With an Adverse Donor/Recipient Profile

Cited by 129 publications

References 16 publications

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

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

Normothermic liver preservation: a new paradigm?

Bioengineering approaches to organ preservation ex vivo

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