Successful Heart Transplant after Ten Hours Out-of-body Time using the TransMedics Organ Care System

Stamp, Nikki; Shah, Amit; Vincent, V.; Wright, B M; Wood, Clare; Pavey, Warren; Cokis, C; Chih, Sharon; Dembo, L.; Larbalestier, Rob

doi:10.1016/j.hlc.2015.01.005

Cited by 67 publications

(54 citation statements)

References 3 publications

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“…While a high perfusate lactate concentration correctly identified hearts that developed primary graft failure (high specificity), the ability to rule out graft dysfunction in hearts with a low lactate concentration was much poorer (low sensitivity). This is exemplified by a recent case report describing the preservation of an ideal donor heart on the OCS Heart over an 8.4 h period (Stamp et al 2015). Despite the maintenance of normal perfusion parameters and lactate levels during the preservation period, the heart became edematous and primary graft dysfunction occurred following transplantation, necessitating support with extracorporeal membrane oxygenation.…”

Section: Discussionmentioning

confidence: 99%

Assessment of donor heart viability during ex vivo heart perfusion

White

Ambrose

Müller

et al. 2015

Can. J. Physiol. Pharmacol.

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Ex vivo heart perfusion (EVHP) may facilitate resuscitation of discarded donor hearts and expand the donor pool; however, a reliable means of demonstrating organ viability prior to transplantation is required. Therefore, we sought to identify metabolic and functional parameters that predict myocardial performance during EVHP. To evaluate the parameters over a broad spectrum of organ function, we obtained hearts from 9 normal pigs and 37 donation after circulatory death pigs and perfused them ex vivo. Functional parameters obtained from a left ventricular conductance catheter, oxygen consumption, coronary vascular resistance, and lactate concentration were measured, and linear regression analyses were performed to identify which parameters best correlated with myocardial performance (cardiac index: mL·min(-1)·g(-1)). Functional parameters exhibited excellent correlation with myocardial performance and demonstrated high sensitivity and specificity for identifying hearts at risk of poor post-transplant function (ejection fraction: R(2) = 0.80, sensitivity = 1.00, specificity = 0.85; stroke work: R(2) = 0.76, sensitivity = 1.00, specificity = 0.77; minimum dP/dt: R(2) = 0.74, sensitivity = 1.00, specificity = 0.54; tau: R(2) = 0.51, sensitivity = 1.00, specificity = 0.92), whereas metabolic parameters were limited in their ability to predict myocardial performance (oxygen consumption: R(2) = 0.28; coronary vascular resistance: R(2) = 0.20; lactate concentration: R(2) = 0.02). We concluded that evaluation of functional parameters provides the best assessment of myocardial performance during EVHP, which highlights the need for an EVHP device capable of assessing the donor heart in a physiologic working mode.

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Section: Discussionmentioning

confidence: 99%

Assessment of donor heart viability during ex vivo heart perfusion

White

Ambrose

Müller

et al. 2015

Can. J. Physiol. Pharmacol.

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“…Study results showed that 30-day patient and graft survival, serious adverse events, incidence of severe rejection, and length of intensive care unit stay were similar between the two groups, thereby demonstrating non-inferiority of ex vivo perfusion during donor heart transport. Other studies have reported that ex vivo perfusion may reduce the incidence of primary graft dysfunction (52) and has been used to transport a heart with a 10-hour out of body time (53). In fact, the Harefield Hospital transplant program in London, UK routinely uses normothermic perfusion for heart transplants, with the rationale of limiting cold ischemia, particularly for redo sternotomy recipients and those undergoing complex VAD explants (54).…”

Section: Ex-vivo Cardiac Perfusionmentioning

confidence: 99%

Donor selection in the modern era

Khush

2018

Ann. Cardiothorac. Surg.

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The growing disparity between the supply of donor hearts for transplantation and the demand for such organs has led to liberalization of the criteria for donor heart acceptance over the past few decades. The upper age limit and size restrictions for donor heart acceptance continue to be revised and hearts are being routinely used from donors with left ventricular dysfunction, left ventricular hypertrophy (LVH), cocaine use, multiple medical co-morbidities and after cardiopulmonary resuscitation. This article reviews recent data for use of such "expanded criteria" donor hearts and suggests ways to further increase the donor pool, including use of hearts from donors with hepatitis C and after circulatory determination of death. Donor biomarkers and risk scores may eventually aid in heart acceptance decisions, while ethical issues surrounding information sharing with transplant recipients remain a topic of great debate.

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“…22,23 Keeping with these principles, the OCS includes constant infusion of TransMedics Maintenance Solution, which includes insulin, glucocorticoids, bicarbonate, adenosine, and low dose epinephrine. 9,10,24 However, given that preservation time appears to remain limited, the current list of OCS perfusate ingredients must lack essential components. Our experiments suggest that some factor or factors in plasma from a live animal, and/or toxin removal by the live animal, are essential for prolonged perfusion.…”

Section: Discussionmentioning

confidence: 99%

Normothermic Ex Vivo Heart Perfusion: Effects of Live Animal Blood and Plasma Cross Circulation

et al. 2017

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Prolonged normothermic ex-vivo heart perfusion (NEVHP) could transform cardiac transplantation. To help identify perfusate components that might enable long-term perfusion, we evaluated the effects of cross-circulated whole blood and cross-circulated plasma from a live paracorporeal animal on donor porcine hearts preserved via NEVHP. Standard perfusion (n=40) utilized red blood cell/plasma perfusate and Langendorf technique for a goal of 12 hours. Cross-circulation groups used a similar circuit with the addition of cross-circulated venous whole blood (XC-Blood; n=6) or cross-circulated filtered plasma (XC-Plasma; n=7) between a live paracorporeal pig under anesthesia and the perfusate reservoir. Data included oxygen metabolism, vascular resistance, lactate production, left ventricular function, myocardial electrical impedance, and histopathologic injury score. All cross-circulation hearts were successfully perfused for 12 hours, compared to 22 of 40 standard perfusion hearts (55%; p=0.002). Both cross-circulation groups demonstrated higher oxygen consumption and vascular resistance than standard hearts from hours 3–12. No significant differences were seen between XC-Blood and XC-Plasma hearts in any variable, including left ventricular dP/dT after 12 hours (1478±700mmHg/s vs. 872±500; p=0.17). We conclude that cross circulation of whole blood or plasma from a live animal improves preservation of function of perfused hearts, and cross-circulated plasma performs similarly to cross-circulated whole blood.

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Successful Heart Transplant after Ten Hours Out-of-body Time using the TransMedics Organ Care System

Abstract: We report some of the salient points of the process and discuss the utility of this technology to an Australian transplant unit.

Cited by 67 publications

References 3 publications

Assessment of donor heart viability during ex vivo heart perfusion

Assessment of donor heart viability during ex vivo heart perfusion

Donor selection in the modern era

Normothermic Ex Vivo Heart Perfusion: Effects of Live Animal Blood and Plasma Cross Circulation

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