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Machine Perfusion for Human Heart Preservation: A Systematic Review.
Guangqi Qin1, Victoria Jernryd1, Trygve Sjöberg1
1Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skane University Hospital, Lund, Sweden.
Summary
Machine perfusion (MP) for donor hearts shows outcomes comparable to static cold storage (SCS). Normothermic MP (NMP) shows promise for high-risk and donation after circulatory death (DCD) hearts, but more research is needed.
Area of Science:
- Cardiovascular Surgery
- Organ Transplantation
- Medical Technology
Background:
- Static cold storage (SCS) is the current standard for donor heart preservation.
- Machine perfusion (MP) offers a potential alternative to expand the donor pool and increase organ utilization.
- Clinical data on MP for heart transplantation requires critical assessment.
Purpose of the Study:
- To review and critically evaluate existing clinical data on machine perfusion (MP) in heart transplantation.
- To compare the efficacy and safety of MP techniques against traditional static cold storage (SCS).
- To identify potential benefits of MP, particularly for high-risk donors and donation after circulatory death (DCD) organs.
Main Methods:
- Comprehensive literature search of Medline (PubMed), Cochrane, Embase, and clinicaltrials.gov.
- Inclusion of 40 publications: 18 articles, 17 conference abstracts, and 5 ongoing clinical trials.
- Categorization of MP into hypothermic (HMP) and normothermic (NMP) systems for analysis.
Main Results:
- MP, both HMP and NMP, demonstrated clinical outcomes comparable to SCS.
- Normothermic MP (NMP) showed particular benefit for high-risk donor hearts and DCD hearts.
- Single-center studies suggest NMP can preserve hearts from donors outside standard criteria effectively.
Conclusions:
- Machine perfusion (MP) is non-inferior to static cold storage (SCS) for heart transplantation based on current data.
- Normothermic MP (NMP) may offer advantages for specific donor populations, including DCD hearts.
- Hypothermic MP (HMP) presents theoretical safety and simplicity advantages over NMP, but further robust studies are essential for definitive conclusions.
