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DOI: 10.1055/s-0034-1367313
Outcomes after cardiac transplantation using organ care system in extended criteria donors and high risk recipients
Background: The severe shortage of available donor organs has resulted in increasing attempts to utilize marginal organs for transplantation. While these attempts may increase organ availability, they result in higher risk organ-recipient combinations. The individual risk-benefit ratio is further affected by the increasing complexity of today's recipients (e.g. ventricular assist devices (VAD), severe pulmonary hypertension (PHT), age or previous surgery). The Organ Care System (OCS) allows for preservation and transport of a continuously perfused heart in a near physiological environment at 34°C in a beating state. This allows for extended out of body times, avoids the detrimental effect of cold ischemic storage and provides additional assessment. We describe our experience with the OCS in a consecutive series of patients transplanted at our institution.
Methods: Data was collected prospectively for all patients transplanted with the OCS (n = 11) between 22nd February and 9th June 2013. Donor, recipient data and postoperative results were analyzed.
Results: One patient died 44 days after transplantation due to an early small bowel and colon ischemia. Other patients were weaned off bypass at the first attempt and none of them required mechanical support. In the entire patient cohort no graft developed right heart failure. Among survived patients, time on inotropic support was 87 ± 58 h, duration of mechanical ventilation 51 ± 35 h and ICU stay 150 ± 105 h. At follow up, 128 ± 44 days (67-191) graft function was preserved in all cases; left-ventricular ejection fraction was 72 ± 5%, 68 ± 7% and 69 ± 5% after 1, 2 and 3 months, respectively.
Conclusions: The OCS allows expanding the donor pool by either utilizing organs previously not considered for transplantation (e.g. marginal organ, long transport time) or transplanting higher risk graft-recipient combinations (previous operations, VADs, PHT). In these patients the observed mortality and morbidity was more favorable than expected given the combined risk profile of donor-recipient. If these results are reproducible, OCS preservation may become the standard of care in these types of situations.