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Ice-cold storage or controlled hypothermia to preserve marginal grafts in high-risk heart transplantation
Andrea Lechiancole1, Sandro Sponga1,2, Gregorio Gliozzi1,3
1Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy.
Insights
The Paragonix SherpaPak cardiac transport system (PSP) may offer better heart graft protection compared to standard ice-cold storage (ICS) in high-risk heart transplants. This novel system shows a trend towards reduced graft dysfunction and myocardial damage.
Area of Science:
- Cardiovascular Surgery
- Organ Transplantation
- Biomedical Engineering
Background:
- Extended-criteria donor grafts are often used in high-risk heart transplant recipients.
- Optimizing donor heart preservation is critical for successful transplantation outcomes.
- Standard ice-cold storage (ICS) is the conventional method for cardiac graft preservation.
Purpose of the Study:
- To compare the effectiveness of the Paragonix SherpaPak cardiac transport system (PSP) against standard ice-cold storage (ICS).
- To evaluate graft protection and patient outcomes in high-risk heart transplant recipients using extended-criteria donor grafts.
Main Methods:
- Retrospective analysis of 90 heart transplantations (HTx) using extended-criteria donors in high-risk patients.
- Grafts were preserved using either ICS (n=60) or PSP (n=30) between January 2020 and December 2023.
- Assessment of patient outcomes, complications, and histological myocardial damage via endomyocardial biopsies at multiple time points.
Main Results:
- No significant difference in 30-day mortality (3% for both groups) or 1-year survival (90% PSP vs. 88% ICS).
- PSP group showed a trend towards lower rates of moderate-to-severe graft dysfunction (7% vs. 20%) and bradi-arrhythmias (3% vs. 15%).
- Histological analysis revealed absent severe cellular/endothelial damage in PSP grafts, with higher contraction band necrosis in ICS grafts post-reperfusion.
Conclusions:
- The Paragonix SherpaPak system demonstrates a potential advantage in protecting donor hearts during preservation in high-risk transplant scenarios.
- PSP may mitigate myocardial damage and reduce the incidence of early graft dysfunction compared to ICS.
Background:
To evaluate the effectiveness of the Paragonix SherpaPak cardiac transport system (PSP) compared to the standard ice-cold storage (ICS) in extended-criteria donor grafts implanted in high-risk recipients.
Methods:
Data of all HTx at the University Centers of Udine and Bologna, between January 2020 and December 2023, employing extended-criteria donors in high-risk HTx conditions were retrospectively analyzed. Patient outcomes and complications after HTx were assessed. Endomyocardial biopsies were performed in donor hearts immediately after retrieval (T0), before implantation (T1) and at reperfusion (T2) to evaluate signs of myocardial damage.
Results:
Overall, 90 patients who had heart transplantation (HTx) with a donor graft preserved with either ICS (n = 60) or PSP (n = 30) were included in the study. The 30-day mortality was 3% in both groups (p = 0.99), and 1-year survival 90% and 88% (p = 0.89) for recipients transplanted with PSP and ICS preserved grafts. Rates of moderate-to-severe graft dysfunction and bradi-arrhythmias for PSP and ICS groups were 7% versus 20% (p = 0.08), and 3% versus 15% (p = 0.09). Histologically, severe degrees of cellular and endothelial damage were absent in all PSP grafts while severe degree of contraction bands were higher in ICS hearts at T2.
Conclusions:
In high-risk donor-recipient matching, donor heart preservation with PSP seems to show a tendency toward better graft protection.
