(144) - Heart Transplantation Following Donor Circulatory Death in Patients Bridged to Transplant with Implantable Left Ventricular Assist Devices

Abstract

Donor shortage necessitates the transplantation of hearts outside of standard acceptability criteria. Recently, it has been demonstrated that hearts from adult donors after circulatory death (DCD) can be transplanted into low-risk recipients using normothermic reperfusion. Here we show that this is also feasible despite complex recipients bridged to heart transplantation with long-term left ventricular assist devices Heart retrieval from Maastricht category III, controlled, donors entailed preservation and transfer to the Transmedics Inc. Organ Care System (OCS) for resuscitation and further assessment. Recipient 1 was male, 52, with a Heartware HVAD left ventricular assist device (LVAD). The donor was male, 39, with a cardiac arrest on admission (unknown downtime, estimated >20 minutes) and a drug addiction history and norepinephrine at 0.4 mcg/kg/min. Recipient 2 was male, 26, supported on a Thoratec Heartmate II LVAD with a severe LVAD infection and was on tirofiban and heparin infusions due to ongoing pump thrombosis. The female donor, 21, became a DCD donor following a head injury. Times from withdrawal of treatment to asystole were 7 and 15 minutes, with OCS perfusion times of 360 and 307 min, respectively. Neither recipients required post-operative circulatory support and both were discharged and remain well with good ventricular function 141 and 142 days after transplantation, respectively. It has been reported that DCD heart transplantation is feasible in conservatively selected donors and recipients. Here, we demonstrate successful short-term outcomes in spite of adverse risk factors including LVAD bridge to transplantation.