Machine Perfusion for Human Heart Preservation: A Systematic Review

Abstract

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.

Normothermic Ex Vivo Machine Perfusion of Discarded Human Pancreas Allografts: A Feasibility Study

“…Strategies that will allow for the assessment and repair of pancreas allografts have the potential to reverse this trend in pancreas donation. Normothermic ex vivo machine perfusion (NEVPP) has been successfully used for the preservation of liver [ 13 , 14 ], kidney [ 15 , 16 ], heart [ 17 ], and lung allografts [ 18 ] but has only scarcely been studied for the pancreas.…”

The role of ex-situ perfusion for thoracic organs

“…Prolonged cold ischemia time (CIT) and ischemia–reperfusion injury (IRI) represent significant risk factors for worse short-term and long-term outcomes; however, machine perfusion bears the potential to remedy through storing the explanted organ in a nonischemic and normothermic perfused, nearly physiological status [7,8]. Hereby, machine perfusion seems to reduce graft immunogenicity by clearing resident leukocytes, reducing recipient T-cell recruitment and infiltration, and lowering inflammatory cytokines [7,9 ▪▪ ].…”