Ex-vivo Perfusion on Marginal Donors in Heart Transplantation: Clinical Resuts and Pathological Findings

Sponga, Sandro; Ferrara, Veronica; Beltrami, AP; Bonetti, Antonella; Cantarutti, Cristina; Caragnano, Angela; Ortolani, Fulvia; Lechiancole, Andrea; Esposito, Roberta; Nora, Concetta Di; Tursi, V.; Nalli, Chiara; Livi, Ugolino

doi:10.1016/j.healun.2019.01.089

Cited by 7 publications

(7 citation statements)

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“…In nine publications, the OCS was compared with SCS ( Table 2 ) ( 14 , 15 , 25 – 31 ). The results of three of these studies favored OCS perfusion ( 27 , 29 , 31 ), including two studies that used the OCS for high-risk cases ( 29 , 31 ). The other six studies did not find any significant difference in the primary outcomes ( 14 , 15 , 25 , 26 , 28 , 30 ).…”

Section: Resultsmentioning

confidence: 99%

“…The results showed that OCS preservation significantly reduced all these proteins. Seven studies compared short- and long-term patient survival rates and found no significant difference between the groups ( 14 , 15 , 25 , 28 - 31 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Machine Perfusion for Human Heart Preservation: A Systematic Review

et al. 2022

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Currently, static cold storage (SCS) of hearts from donations after brainstem death remains the standard clinically. However, machine perfusion (MP) is considered an approach for donor organ management to extend the donor pool and/or increase the utilization rate. This review summarizes and critically assesses the available clinical data on MP in heart transplantation. We searched Medline (PubMed), Cochrane, Embase, and clinicaltrials.gov, along with reference lists of the included publications and identified 40 publications, including 18 articles, 17 conference abstracts, and five ongoing clinical trials. Two types of MP were used: hypothermic MP (HMP) and normothermic MP (NMP). Three studies evaluated HMP, and 32 evaluated NMP. Independent of the system, MP resulted in clinical outcomes comparable to traditional SCS. However, NMP seemed especially beneficial for high-risk cases and donation after circulatory death (DCD) hearts. Based on currently available data, MP is non-inferior to standard SCS. Additionally, single-centre studies suggest that NMP could preserve the hearts from donors outside standard acceptability criteria and DCD hearts with comparable results to SCS. Finally, HMP is theoretically safer and simpler to use than NMP. If a machine malfunction or user error occurs, NMP, which perfuses a beating heart, would have a narrower margin of safety. However, further well-designed studies need to be conducted to draw clear conclusions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Machine Perfusion for Human Heart Preservation: A Systematic Review

et al. 2022

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“…Favorable donor characteristics should also be considered when interpreting the results of this study. Since PROCEED II, many published or ongoing investigations sought to evaluate the use of OCS in extended‐criteria donors and donors after circulatory death 19–25 . In these scenarios, besides minimizing cold ischemic time, the OCS provided additional benefits of allowing resuscitation and careful assessment of graft quality before definitive transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Since PROCEED II, many published or ongoing investigations sought to evaluate the use of OCS in extended-criteria donors and donors after circulatory death. [19][20][21][22][23][24][25] In these scenarios, besides minimizing cold ischemic time, the OCS provided additional benefits of allowing resuscitation and careful assessment of graft quality before definitive transplantation. Thus, it is important to note that the results of the current study only apply to standard risks donors, and no inference regarding extended-criteria donors can be made.…”

Section: F I G U R Ementioning

confidence: 99%

Long‐term outcomes after heart transplantation using ex vivo allograft perfusion in standard risk donors: A single‐center experience

Chen

Singer-Englar

Kobashigawa

et al. 2022

Clinical Transplantation

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Introduction The Organ Care System (OCS) is an ex vivo perfusion platform for donor heart preservation. Short/mid‐term post‐transplant outcomes after its use are comparable to standard cold storage (CS). We evaluated long‐term outcomes following its use. Methods Between 2011 and 2013, 38 patients from a single center were randomized as a part of the PROCEED II trial to receive allografts preserved with CS (n = 19) or OCS (n = 19). Endpoints included 8‐year survival, survival free from graft‐related deaths, freedom from cardiac allograft vasculopathy (CAV), non‐fatal major adverse cardiac events (NF‐MACE), and rejections. Results Eight‐year survival was 57.9% in the OCS group and 73.7% in the CS group (p = .24). Freedom from CAV was 89.5% in the OCS group and 67.8% in the CS group (p = .13). Freedom from NF‐MACE was 89.5% in the OCS group and 67.5% in the CS group (p = .14). Eight‐year survival free from graft‐related death was equivalent between the two groups (84.2% vs. 84.2%, p = .93). No differences in rejection episodes were observed (all p > .5). Conclusions In select patients receiving OCS preserved allografts, late post‐transplant survival trended lower than those transplanted with an allograft preserved with CS. This is based on a small single‐center series, and larger numbers are needed to confirm these findings.

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