The Organ Care System Heart in High Risk Transplantation with an Adverse Donor/Recipient Profile. Ready for Daily Practice?

Objectives: A severe shortage of available donor organs has created an impetus to utilize extended criteria organs for heart transplantation. While 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: Fifty hearts were preserved using OCS between February 2013 and September 2014 of which 40 (80%) were transplanted. Procedures were classified as high risk based on donor factors: transport time > 2.5 hours with estimated ischemic time above 4hours, left ventricular ejection fraction < 50%, left ventricular hypertrophy, donor cardiac arrest, alcohol/drug abuse, coronary artery disease; and/or recipient factors: mechanical circulatory support or elevated pulmonary vascular resistance.

Results: Donor and recipient age was 41 ± 12 years and 44 ± 13 years, respectively. Allograft cold ischemic time was 84 ± 17 minutes and OCS perfusion time was 283 ± 90 minutes. The median Intensive Care Unit stay was 6,5(4;17) days. The overall 30-day survival with preserved allograft function was 92%. The mean postoperative left ventricular ejection fraction was 64 ± 5%.

Conclusions: Use of the OCS is associated with markedly improved short term outcomes and transplant activity by allowing utilization of organs previously not considered suitable for transplantation and/or selection of higher risk recipients.