CARC21: Outcomes in Transplant Recipients Bridged with Impella Support: A GUARDIAN-Heart Subgroup Analysis

Abstract

Background: The 2018 UNOS allocation changes prioritized recipients bridged with temporary MCS, which has recently increased in use. Also in 2018, the SherpaPak Cardiac Transport System (CTS) was introduced, which maintains donor heart temperatures continuously between 4°C - 8°C, potentially minimizing freezing-related myocardial injury. A subgroup analysis of the GUARDIAN Heart Registry examined outcomes in transplant recipients bridged using Impella. Methods: The GUARDIAN registry is an international, multicenter registry assessing outcomes after heart transplant comparing CTS preservation and traditional ice-cold (ICE) donor heart storage. Retrospective review of clinical outcomes in recipients bridged with an Impella were examined using summary statistics. Further analysis with ongoing enrollment will be available for presentation. Results: A total of 47 recipients with an Impella device received donor hearts preserved using either CTS (n=33) vs ICE (n=14). The two groups had similar baseline characteristics except the CTS cohort had significantly longer average ischemic time (175.3 vs and 223.9 minutes, p value = 0.02, ICE vs CTS,) and greater procurement distance travelled (170.2 vs 447.5 miles, p value < 0.001, ICE vs CTS). Post-transplant rates of severe PGD were low (14.3% vs 3.0%, p value = 0.15, ICE vs CTS, respectively). Survival was excellent with 100% 30-day survival in both cohorts. Conclusions: Despite significantly longer ischemic times by 48.6 minutes and over 2.5x farther organ procurement distance travelled, the use of the CTS was associated with excellent post-transplant outcomes in patients bridged using an Impella device. Considering ischemic time is a known risk factor for post-transplant PGD, these data support continued study of CTS use to optimize outcomes, in particular in an era of increasing distance travelled for organ procurement and complex bridging strategies.