Single Centre Experience with Ex-Vivo Preservation on Marginal Donors in Heart Transplantation

Sandro Sponga, Veronica Ferrara, Andrea Lechiancole, Sandro Nalon, Giorgio Guzzi, Chiara Nalli, Enrico Spagna, Vincenzo Tursi, Angela Caragnano, Antonio P. Beltrami, Ugolino Livi

University Hospital of Udine, Udine, Italy

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–A

Abstract

Objective

The ex-vivo perfusion performed with the Organ Care System (OCS, Transmedics, Inc, Boston) permits to transport the donor heart in a warm beating state, to reduce ischemic time and allow graft evaluation, in order to expand donor inclusion criteria. We report our single-centre experience with the OCS.

Methods.

Between 2007 and 2017, 29 hearts were preserved with OCS in our institution. Recipients in cardiogenic shock needing ECMO support and standard donors were not considered in the study to obtain a homogeneous population, leaving 19 marginal donors: age>60 years (n=1), LVEF<50% (n=1), coronaropathy (n=3), cardiac arrest (n=3) and expected ischemic time>5 hours (n=13). Recipientsage was 58.4±6.3 years, 4 (27%) of them had Ventricular Assist Device (VAD), 9 (60%) previous cardiac surgery, 4 (27%) chronic renal failure and 2 (13%) extracardiac arteriopathy.

Bioptic samples were collected at time of heart retrieval and after OCS transport.

Results.

The cold ischemia time was 141±27 minutes and the OCS preservation time was 235±70 minutes. Despite OCS preservation 4 organs were not suitable for Heart Transplantation (HTx). The remaining 15 grafts were successfully transplanted and there wasn’t early graft failure. All patients showed spontaneous sinus rhythm after decplamping and 1 (7%) needed IABP support. There was no early and late death.

Three (20%) patients developed acute rejection > grade 2, 4 (27%) renal failure, that requiring CVVH in 1 (7%); mechanical ventilation time was 48.5±55.4 hours. All patients had a good LVEF (68.5±6.8%) and sPAP (32.3±5.3 mmHg) and the mean ICU stay was 5.9±4.6. Five grafts that showed vacuolization at retrieval, had a reversal tissue damage after OCS support.

Conclusions.

The OCS preservation allows to extend the recruitment of marginal donor hearts, to identify hidden cardiac pathologies and to reverse tissue damage.