Heart transplantation of patients with ventricular assist devices: impact of normothermic ex-vivo preservation using organ care system compared with cold storage

Rymbay Kaliyev,Svetlana Novikova,Linar Faizov,Nurlan Smagulov,Zhuldyz Nurmykhametova,Assel Medressova,Yuriy Pya,Serik Bekbossynov,Timur Lesbekov,Makhabbat Bekbossynova,Robertas Samalavicius

doi:10.1186/s13019-020-01367-w

Abstract

BackgroundOrgan Care System (OCS) minimizes the cold ischemic time and allows for optimization of logistics and meticulous recipient preparation. Impact of normothermic ex-vivo preservation using OCS compared with cold storage (CS) for prolonged heart preservation especially beneficial for high-risk recipients bridged to transplantation with Mechanical Circulatory Support (MCS).MethodsBetween 2012 and 2018, we performed a retrospective single-center review of prospectively collected data. All patients who underwent heart transplantation with MCS using the OCS Heart (n = 25) versus standard cold storage (n = 10) were included in this study.ResultsDuring this period, 353 patients were implanted with left ventricular assisted device (LVAD) and 35 (10%) were bridged to heart transplantation. There was no significant difference in donor and recipient characteristics and risk factors. The Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was a trend towards higher estimated risk of death at 1y in the OCS group (14.2 vs. 10.8% p = 0.083). Mean total ischemic time during preservation was statistically significantly longer in CS vs OCS group (210 (23) Vs 74.6 (13) min p = 0.001). Median ex vivo normothermic heart perfusion time in OCS was 348.4(132; 955) min. There was significant difference in total out of body time between OCS group 423(67) Vs CS group 210(23) min p = 0.002). All patients were alive on the 30th days post implant in CS groups and 96% in OCS group (p = 0.5).ConclusionNormothermic ex-vivo preservation of the allograft during transportation with the organ care system might be beneficial for long-time out of body organ preservation in comparison of cold storage especially for recipients on mechanical circulatory support.

Highlights

Organ Care System (OCS) minimizes the cold ischemic time and allows for optimization of logistics and meticulous recipient preparation
We report a single-center experience of impact of normothermic ex-vivo preservation using organ care system compared with Cold storage for prolonged heart preservation especially beneficial for highrisk recipients bridged to transplantation with Mechanical Circulatory Support
There was a trend slightly higher donor age on the OCS group vs cold storage (CS) (41.3 ± 9.3 Vs 38.3 ± 11.5 yo; p = 0.2), with 92% vs 70% male donors

Summary

Introduction

Organ Care System (OCS) minimizes the cold ischemic time and allows for optimization of logistics and meticulous recipient preparation. Impact of normothermic ex-vivo preservation using OCS compared with cold storage (CS) for prolonged heart preservation especially beneficial for high-risk recipients bridged to transplantation with Mechanical Circulatory Support (MCS). Success in heart transplant depends on the quality of the donor heart, procurement, preservation and storage of the graft, the complexity of the operation and duration of graft ischemia. Under conventional conditions of donor organ preservation, i.e., cardioplegic arrest and cold storage, prolonged cold ischemia time is by far the greatest risk factor for primary allograft dysfunction and death [4]. Ex vivo normothermic preservation, using OCS minimizes the cold ischemic time and allows for optimization of logistics and meticulous recipient preparation. Our center is sole transplant center in our country, and donor hearts are often retrieved from distant regions to be transplanted at our center

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Discussion

Conclusion