Heart transplant outcomes in patients with mechanical circulatory support: cold storage versus normothermic perfusion organ preservation

Abstract

OBJECTIVES Patients with mechanical circulatory support bridged to a heart transplant (HTx) are at higher risk of postoperative graft dysfunction. In this subset, a mode of graft preservation that shortens graft ischaemia should be beneficial. METHODS The outcomes of 38 patients on mechanical circulatory support (extracorporeal life support, left ventricular assist device and biventricular assist device) who received a HTx between 2015 and 2020 were analysed according to the method of graft preservation: cold storage (CS) group, 24 (63%) or ex vivo perfusion (EVP) group, 14 (37%). RESULTS The median age was 57 (range 30–73) vs 64 (35–75) years (P = 0.10); 88% were men (P = 0.28); extracorporeal life support was more frequent in the CS group (54% vs 36%; P = 0.27) versus left ventricular and biventricular assist devices in the EVP group (46% vs 64%; P = 0.27). Clamping time was shorter in the EVP group (P < 0.001) and ischaemic time >4 h was higher in the CS group (P = 0.01). Thirty-day mortality was 13% (0–27%) in the CS group and 0% (P = 0.28) in the EVP group. A significantly lower primary graft failure [7% (0–23%) vs 42% (20–63%); P = 0.03] was observed in the EVP group. Survival at 1 year was 79 ± 8% (63–95%) in the CS group and 84 ± 10% (64–104%) in the EVP group (P = 0.95). CONCLUSIONS Our results support the use of ex vivo graft perfusion in patients on mechanical circulatory support as a bridge to a HTx. This technique, by shortening graft ischaemic time, seems to improve post-HTx outcomes.

Ex vivo donor heart preservation in heart transplantation

“…We have recently reported our experience with HT in patients with mechanical circulatory support, comparing the results obtained either with CS or OCS for donor heart preservation. 2 Our results, in a series of 38 patients during a 5-year period, indicate that OCS is superior to CS since it reduces significantly the graft ischemic times and accordingly improving post-HT outcomes. Therefore, our experience supports the use of ex vivo graft perfusion in patients on mechanical circulatory support as a bridge to an HTx.…”

Response to the manuscript “ex vivo donor heart preservation in heart transplantation (HTx)—Is this the solution to increase the donor pool?”

“…4 Median ex vivo normothermic heart perfusion time in OCS was 348.4 min (132-955)-5.8 h, which corresponds to the data of our Italian colleagues (320 ± 76 min). 3 All patients were alive on the 30th days postimplant in CS groups and 96% in OCS group (p = .5). The longest perfusion in OCS in experience of our center was 15 h 55 min with total donor cross-clamp time (time from cross-clamp of the donor aorta to cross-clamp removal in the patient) of 17 h 03 min.…”

“…Prof. Sponga et al 2,3 suggest the use of ex vivo graft perfusion in patients on MCS as a bridge to a HTx but no longer than 8 h. From 2011 to this date 81 patients were transplanted with the OCS used in 59 cases (72.8%) in our center. In a cohort at our center, patients who underwent HTx with MCS using the OCS (n = 25) were compared to standard cold storage (n = 10).…”

Expanding Donor Heart Utilization Through Machine Perfusion Technologies

“…In terms of patients who Fig. 1 Overall comparison of current machine perfusion technologies including normothermic machine perfusion with the Organ Care System™, normothermic regional perfusion, and hypothermic machine perfusion with the XVIVO Perfusion system have been supported on a ventricular assist device, compared to SCS hearts, the use of NMP for donor hearts has reduced the need for post-transplant mechanical support [6], reduced cardiopulmonary bypass times, and reduced the incidence of early PGD [6,7]. Both SCS and NMP groups showed similar post-transplant survival at 1 month [6] and 1 year with a lower incidence in acute rejection [7].…”