Heart Preservation with the Organ Care System in Germany: Revival in High-Risk Recipients

Objectives: The Organ Care System (OCS) Heart is noninferior compared with standard cold storage for preservation of donor hearts. We hypothesized that its properties for prolonged heart preservation might be especially beneficial for complex high risk recipients with previous cardiac surgery.

Methods: Patients transplanted using the OCS Heart at our two institutions between 10/2016 and 09/2017 were prospectively followed. All recipients were potentially considered eligible, but an effort was made to apply the OCS especially in challenging cases with previous cardiac surgery.

Results: During the study period, among the 36 transplanted patients, 18 (50%) high risk recipients (median age 51 years, 72% male) were transplanted using the OCS for donor (median age 45 years, 56% male) heart preservation. Before transplantation, 17 (94%) recipients (LVAD/BVAD, n = 14; heart transplantation, n = 1; correction of congenital heart defects, n = 2) had a median of 2 previous cardiac operations, 2 (11%) were on ECLS, and 17 (94%) were on the high urgency list. Among the 14 VAD patients, 5 (36%) and 4 (29%) had shown VAD/driveline infections and VAD dysfunctions, respectively. Three (21%) patients had required at least one VAD exchange. All OCS hearts were successfully transplanted. Median OCS perfusion and donor aortic cross-clamp to recipient aortic clamp-opening times were 5.2 and 6.7 hours, respectively. In addition, 3 distant retrievals (Northern Ireland, Lithuania and Slovenia) were only realized for their respective recipients with previous surgery without exceeding the maximum ischemic time because the OCS was available. Postoperatively, 3 (17%) and 11 (61%) patients required re-thoracotomy for bleeding and temporary dialysis, respectively. Two (11%) patients required ECLS due to right heart failure that completely recovered after 4 and 6 days. The first patient showed pulmonary embolism. In the second patient, the donor heart had developed elevated lactate levels in the OCS. One (6%) patient died in-hospital due to sepsis. At discharge, all patients showed a left ventricular ejection fraction >60% in echocardiography. At follow-up end, survival and freedom from biopsy-confirmed rejection (ISHLT grade >1R) were 90% and 94%, respectively.

Conclusion: OCS Heart allowed safe transplantation of surgically complex recipients. Despite preservation time was approaching 7 hours, enabling allocations otherwise not acceptable, patient and graft outcomes were favorable.