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Author Spotlight: Enhancing Donor Heart Preservation Through Isolated Rat Heart Perfusion Studies
Published on: October 4, 2024
Donor Heart Preservation for Heart Transplantation: Single-Center Experience with Three Different Techniques
Andrea Lechiancole1, Gregorio Gliozzi1, Sandro Sponga1,2
1Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, P. le S.M. Misericordia 15, 33100 Udine, Italy.
Insights
New heart preservation methods like Paragonix SherpaPak (PSP) and Organ Care System (OCS) show promise compared to traditional ice-cold storage (ICS), especially in complex cases. These advanced techniques may reduce primary graft dysfunction in heart transplantation (HTx).
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Organ Preservation Technology
Background:
- Traditional ice-cold storage (ICS) is the standard for donor heart preservation, but emerging techniques offer potential advantages.
- Advanced preservation methods, including controlled hypothermia (Paragonix SherpaPak - PSP) and ex vivo normothermic perfusion (Organ Care System - OCS), face challenges in cost and complexity justification.
- Evaluating the efficacy of these novel preservation strategies against ICS is crucial for optimizing heart transplantation (HTx) outcomes.
Purpose of the Study:
- To compare the clinical outcomes of heart transplantation (HTx) using three donor heart preservation strategies: ICS, PSP, and OCS.
- To assess myocardial damage and post-transplant complications associated with each preservation method.
- To determine the suitability of PSP and OCS as alternatives to ICS, particularly in high-risk scenarios.
Main Methods:
- Retrospective analysis of 100 heart transplantations (HTx) performed between January 2020 and August 2024.
- Donor hearts were preserved using ice-cold storage (ICS, n=30), Paragonix SherpaPak (PSP, n=36), or Organ Care System (OCS, n=34).
- Endomyocardial biopsies assessed myocardial damage; patient outcomes and complications were evaluated post-transplant.
Main Results:
- PSP and OCS groups showed higher median IMPACT scores and a trend towards increased use of long-term ventricular assist devices for bridging to HTx compared to ICS.
- Severe cellular damage was more prevalent in hearts preserved with ICS.
- Moderate-to-severe primary graft dysfunction was significantly lower in the PSP (11%) and OCS (17%) groups compared to ICS (37%).
Conclusions:
- Paragonix SherpaPak (PSP) and Organ Care System (OCS) represent viable alternatives to traditional ice-cold storage (ICS) for donor heart preservation.
- These advanced methods are particularly recommended for complex and critical heart transplantation (HTx) cases.
- Further research with larger patient cohorts is warranted to solidify the long-term benefits of PSP and OCS.
Abstract:
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.
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