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Comparative Analysis of Ischemia-Reperfusion Injury in Heart Transplantation: A Single-Center Study Evaluating
Dor Lotan1, Cathrine M Moeller1, Afsana Rahman1
1Division of Cardiology - Center for Advanced Cardiac Care, Columbia University Irving Medical Center - New York Presbyterian Hospital, New York, New York, USA.
Insights
The Paragonix SherpaPak TM Cardiac Transport System (CTS) shows similar ischemia reperfusion injury (IRI) rates to ice-cold storage (ICS) in heart transplants. CTS demonstrates faster IRI recovery and supports remote preservation, expanding the donor pool.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Preservation
Background:
- Increased ischemic times post-2018 heart transplantation (HT) allocation changes.
- Potential association between prolonged ischemia and peri/post-operative complications.
- Need to compare preservation methods for ischemia reperfusion injury (IRI).
Purpose of the Study:
- Compare IRI in hearts preserved with ice-cold storage (ICS) versus Paragonix SherpaPak TM Cardiac Transport System (CTS).
- Evaluate histological markers of IRI, graft rejection, and graft function.
- Assess the impact of preservation method on early and late post-transplant outcomes.
Main Methods:
- Analysis of 90 HT recipients' endomyocardial biopsies (33 ICS, 57 CTS) from Jan 2021-June 2022.
- Single-blinded pathological assessment of coagulative myocyte necrosis (CMN) at 1, 4, and 8 weeks post-HT.
- Monitoring of graft rejection, de novo donor-specific antibodies, and graft function over 8 weeks to 12 months.
Main Results:
- Similar IRI incidence between ICS and CTS groups at 1, 4, and 8 weeks.
- Significant reduction in CMN from week 1 to 4 with CTS (59.3%), but not ICS.
- No significant differences in rejection rates, de novo antibodies, or overall survival between groups up to 12 months.
Conclusions:
- CTS preservation shows comparable IRI rates and clinical outcomes to ICS, despite longer ischemic times.
- Early post-operative recovery from IRI is significantly better with CTS.
- CTS is a viable option for remote organ preservation, potentially expanding the donor heart pool.
Background:
Since the 2018 allocation system change in heart transplantation (HT), ischemic times have increased, which may be associated with peri-operative and post-operative complications. This study aimed to compare ischemia reperfusion injury (IRI) in hearts preserved using ice-cold storage (ICS) and the Paragonix SherpaPak TM Cardiac Transport System (CTS).
Methods:
From January 2021 to June 2022, consecutive endomyocardial biopsies from 90 HT recipients were analyzed by a cardiac pathologist in a single-blinded manner: 33 ICS and 57 CTS. Endomyocardial biopsies were performed at three-time intervals post-HT, and the severity of IRI manifesting histologically as coagulative myocyte necrosis (CMN) was evaluated, along with graft rejection and graft function.
Results:
The incidence of IRI at weeks 1, 4, and 8 post-HT were similar between the ICS and CTS groups. There was a 59.3% statistically significant reduction in CMN from week 1 to 4 with CTS, but not with ICS. By week 8, there were significant reductions in CMN in both groups. Only 1 out of 33 (3%) patients in the ICS group had an ischemic time >240 mins, compared to 10 out of 52 (19%) patients in the CTS group. During the follow-up period of 8 weeks to 12 months, there were no significant differences in rejection rates, formation of de novo donor-specific antibodies and overall survival between the groups.
Conclusion:
The CTS preservation system had similar rates of IRI and clinical outcomes compared to ICS despite longer overall ischemic times. There is significantly more recovery of IRI in the early post operative period with CTS. This study supports CTS as a viable option for preservation from remote locations, expanding the donor pool.
