Normothermic Ex-Vivo Perfusion for Donor Heart Preservation in Transplantation of Patients Bridged with Ventricular Assist Devices

Sponga, Sandro; Ius, F.; Ferrara, Veronica; Royas, S.; Guzzi, G.; Lechiancole, Andrea; Sommer, W.; Kaufeld, Tim; Haverich, Axel; Livi, Ugolino; Warnecke, G.

doi:10.1016/j.healun.2020.01.926

Cited by 2 publications

(9 citation statements)

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“…The other six studies did not find any significant difference in the primary outcomes ( 14 , 15 , 25 , 26 , 28 , 30 ). The total preservation time was reported in five studies, and it was significantly longer in the OCS groups ( 14 , 25 , 26 , 29 , 30 ).…”

Section: Resultsmentioning

confidence: 81%

“…One additional study was identified from the screening of reference lists in the included publications. 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 ).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-one publications, including eight papers ( 7 , 10 , 12 – 16 , 21 ) and 13 conference abstracts ( 5 , 25 – 35 , 40 ) presented results from using the OCS at transplantation of DBD hearts with or without a control group ( Tables 2 , 3 ). Three of these studies were randomized ( Table 2 ).…”

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: 81%

Section: Resultsmentioning

confidence: 99%

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Machine Perfusion for Human Heart Preservation: A Systematic Review

et al. 2022

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“…23 Furthermore, the investigation into ex vivo organ preservation with greater ischemic times may dampen the effects of the insult on overall mortality outcomes. 24 This study has several limitations. Due to the retrospective nature of the study design, the study was limited and may be subject to data entry errors.…”

Section: Discussionmentioning

confidence: 92%

“…As the latter was found to be predictive of outcomes, calculation of estimated ischemic time as a factor in postoperative outcomes should be considered 23 . Furthermore, the investigation into ex vivo organ preservation with greater ischemic times may dampen the effects of the insult on overall mortality outcomes 24 …”

Section: Discussionmentioning

confidence: 99%

A mortality risk score for heart transplants after contemporary ventricular assist device bridging

et al. 2020

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Background: We sought to derive a risk score for 1-year mortality following orthotopic heart transplantation (OHT) in patients bridged with a contemporary centrifugal left ventricular assist device (LVAD). Methods: Adult patients (≥18 years) in the United Network for Organ Sharing database undergoing OHT between 2010 and 2019 who were bridged with a HeartWare or HeartMate III device were included. Derivation and validation cohorts were randomly assigned with a 2:1 ratio. Threshold analysis and multivariable logistic regression were utilized to obtain adjusted odds ratios for 1-year post-OHT mortality. A risk score was generated using these adjusted odds ratios in the derivation cohort and the predictive performance of the composite index was evaluated in the validation set. Results: A total of 3434 patients were identified. In the derivation cohort, the mean age was 53.5 ± 12.1 years and 1758 (76.8%) were male; 1789 (78.1%) were bridged with a HeartWare device. Multivariable logistic regression revealed that recipient age ≥50 years, bilirubin level ≥2.4 mg/dl, ischemic time ≥4 h, and preoperative hemodialysis predicted 1-year post-transplant mortality. Stratification into risk groups in the validation cohort revealed significant differences in postoperative renal failure, stroke, and short-term mortality. One-year post-transplant mortality was 5%, 6.7%, and 14.8% in the low-, moderate-, and high-risk categories, respectively (p < .001). Conclusions: Among patients bridged to OHT with newer generation centrifugal LVADs, older age, increasing bilirubin, longer ischemic time, and pre-OHT dialysis independently predicted post-transplant mortality. The composite risk score based on these factors may assist in patient selection and prognostication in those supported with contemporary LVADs.

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Normothermic Ex-Vivo Perfusion for Donor Heart Preservation in Transplantation of Patients Bridged with Ventricular Assist Devices

Cited by 2 publications

References 0 publications

Machine Perfusion for Human Heart Preservation: A Systematic Review

Machine Perfusion for Human Heart Preservation: A Systematic Review

A mortality risk score for heart transplants after contemporary ventricular assist device bridging

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