Direct Procurement and Perfusion Using Hypothermic Oxygenated Perfusion for DCD Cardiac Allografts in North America

Area of Science:

• Cardiology
• Transplantation Medicine
• Medical Device Technology

Background:

• Donation after Circulatory Death (DCD) offers a viable source for cardiac allografts.
• Established methods for DCD cardiac allograft preservation include direct procurement and perfusion (DPP) and in situ normothermic regional perfusion.
• A new portable hypothermic oxygenated perfusion (HOPE) device is under clinical investigation for cardiac allograft preservation.

Purpose of the Study:

• To report the first North American experience utilizing the HOPE preservation device for direct procurement and perfusion (DPP) recovery of DCD cardiac allografts.
• To detail the clinical experience and early patient outcomes associated with this novel preservation technique.

Main Methods:

• DCD cardiac allografts were procured and preserved using the HOPE platform.
• Allografts were transported to the recipient medical center for orthotopic heart transplantation.
• Patient clinical courses and outcomes were prospectively reported.

Main Results:

• Five end-stage heart failure patients received heart transplants using HOPE-preserved DCD allografts.
• Average preservation time was 298 minutes, with no severe primary graft dysfunction observed.
• One patient experienced mortality due to extracardiac complications, while another required mechanical support for secondary graft dysfunction; survivors maintained allograft function.

Conclusions:

• This initial single-institution experience suggests the HOPE platform is successful for direct procurement and perfusion (DPP) preservation of DCD cardiac allografts.
• The technique demonstrated the ability to transplant adequately functioning allografts with acceptable early patient outcomes.
• Further investigation and broader clinical experience with the HOPE device for DCD cardiac allografts are warranted.