First Use of a Novel System for Allograft Preservation in a Donation After Cardiac Death Heart Transplantation

Heart transplantation (HTx) from controlled donation after circulatory death (c-DCD) is a promising alternative to donation after brain death (DBD), though warm ischemia remains a concern. Thoraco-abdominal normothermic regional perfusion (TANRP) enables in situ functional assessment, but preserving grafts during transport under optimal hypothermic conditions is still a challenge. We describe the first clinical application of a novel temperature-controlled cold static preservation system-Pertravel (Aferetica s.r.l., Bologna, Italy)-in a c-DCD heart transplant. A 62 year old male donor underwent withdrawal of life-sustaining therapy (WLST) followed by 130 minutes of TANRP. After confirming graft viability, the heart was explanted and preserved in the Pertravel system during transport. The recipient, a 66 year old male with end-stage dilated cardiomyopathy, underwent transplantation after 161 minutes of cold ischemia. The Pertravel system maintained stable hypothermia, with no macroscopic graft damage observed. Postoperative recovery was uneventful, with excellent hemodynamic performance, normal echocardiographic findings, and no evidence of acute rejection on serial biopsies. This case demonstrates the feasibility and safety of the Pertravel system for c-DCD heart preservation. Its stable temperature control, ease of use, and favorable outcomes support further investigation in broader clinical settings.