Donor Heart Preservation for Heart Transplantation: Single-Center Experience with Three Different Techniques

Objectives: In addition to traditional ice-cold storage (ICS), other techniques are emerging in the field of donor heart preservation for heart transplantation (HTx). However, in many centers, it could be difficult to justify their use, due to the higher costs and the greater technical complexity compared to ICS. This study aims to analyze the results obtained for HTx at our center employing ICS, controlled hypothermia with Paragonix SherpaPak (PSP), and ex vivo normothermic perfusion with Organ Care System (OCS) as donor graft preservation strategies. Methods: All HTx performed at the University Hospital of Udine, between January 2020 and August 2024, was analyzed and 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, 100 patients were transplanted with a donor heart preserved with ICS (n = 30), PSP (n = 36), or OCS (n = 34). Compared to ICS, PSP and OCS recipients showed a higher median IMPACT score (5 vs. 8 vs. 7, respectively, p = 0.05) and tended to have a higher rate of bridging to HTx with a long-term ventricular assist device (7% vs. 17% vs. 29%, p = 0.06). OCS was more commonly used in cases of expected ischemic time >4 h compared to ICS and PSP (p < 0.01). Histologically, severe degrees of cellular damage were higher in those hearts preserved with ICS. The 30-day mortality was 3% vs. 6% vs. 9% in ICS, PSP, and OCS groups, respectively (p = 0.65). Moderate-to-severe primary graft dysfunction was 37% vs. 11% vs. 17% (p = 0.03) in the three groups. Conclusions: PSP and OCS seem to be valid alternatives to traditional ICS, and their use could be strongly considered, particularly in the most complex and critical settings, until further data are available on more patient experiences.