Evaluation of the Organ Care System in Heart Transplantation With an Adverse Donor/Recipient Profile

• Published in: The Annals of thoracic surgery Vol. 98; no. 6; pp. 2099 - 2106
• Main Authors: García Sáez, Diana, MD, Zych, Bartlomiej, MD, Sabashnikov, Anton, MD, Bowles, Christopher T., PhD, De Robertis, Fabio, MD, Mohite, Prashant N., MD, Popov, Aron-Frederik, MD, PhD, Maunz, Olaf, CCP, Patil, Nikhil P., MRCS, MCh, Weymann, Alexander, MD, Pitt, Timothy, CCP, McBrearty, Louise, CCP, Pates, Bradley, CCP, Hards, Rachel, RN, Amrani, Mohamed, MD, PhD, Bahrami, Toufan, MD, Banner, Nicholas R., MD, PhD, Simon, Andre R., MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-12-2014
• Subjects: Adolescent; Adult; Cardiothoracic Surgery; Female; Follow-Up Studies; Heart Transplantation - methods; Humans; Male; Middle Aged; Retrospective Studies; Surgery; Tissue and Organ Procurement - organization & administration; Tissue Donors - supply & distribution; United Kingdom; Waiting Lists; Young Adult; 34; intraaortic balloon pump; IABP; LVEF; PVR; LVAD; left ventricular ejection fraction; HVAD; Organ Care System; HeartWare left ventricular assist device; left ventricular assist device; pulmonary vascular resistance; OCS
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2014.06.098

Background A severe shortage of available donor organs has created an impetus to use extended criteria organs for heart transplantation. Although such attempts increase donor organ availability, they may result in an adverse donor-recipient risk profile. The TransMedics Organ Care System (OCS) (TransMedics, Inc, Boston) allows preservation of the donor heart by perfusing the organ at 34°C in a beating state, potentially reducing the detrimental effect of cold storage and providing additional assessment options. We describe a single-center experience with the OCS in high-risk heart transplant procedures. Methods Thirty hearts were preserved using the OCS between February 2013 and January 2014, 26 of which (86.7%) were transplanted. Procedures were classified as high risk based on (1) donor factors, ie, transport time more than 2.5 hours with estimated ischemic time longer than 4 hours, left ventricular ejection fraction (LVEF) less than 50%, left ventricular hypertrophy (LVH), donor cardiac arrest, alcohol/drug abuse, coronary artery disease or (2) recipient factors, ie, mechanical circulatory support or elevated pulmonary vascular resistance (PVR), or both. Results Donor and recipient age was 37 ± 12 years and 43 ± 13 years, respectively. Allograft cold ischemia time was 85 ± 17 minutes and OCS perfusion time was 284 ± 90 minutes. The median intensive care unit stay was 6 days. One death (3.8%) was observed over the follow-up: 257 ± 116 (109–445 days). There was preserved allograft function in 92% of patients, with a mean LVEF of 64% ± 5%. Conclusions Use of the OCS is associated with markedly improved short-term outcomes and transplant activity by allowing use of organs previously not considered suitable for transplantation or selection of higher risk recipients, or both.