Purpose
Utilising pharmacological ischaemic post-conditioning strategies, we demonstrated excellent functional recovery in DCD hearts following 30 minutes warm ischaemia time (WIT)1. The aim of this study was to assess recovery of these hearts post orthotopic transplantation (Tx) and using a clinically approved Organ Care System (Transmedics OCS) for preservation. We hypothesized that the Transmedics OCS would provide a platform to gauge the viability of DCD hearts beforeTx.
Methods and Materials
Hearts were exposed to 30 mins WIT in a DCD asyphyxia porcine model, before being flushed with supplemented Celsior (glyceryl trinitrate (GTN), Erythropoietin (EPO) and Zoniporide – post-conditioning strategy). Hearts were explanted onto the Transmedics OCS (t=3.5 hrs), recovery assessed by evaluating cardiac rhythm, lactate extraction & overall lactate trends. Hearts deemed to be viable underwent orthotopic Tx.
Results
7 DCD hearts have been assessed to-date, all recovered to a sinus rhythm, 6/7 hearts had lactate profiles compatible with heart viability for transplantation. [figure 1] Excluding 2 recipient animals (malignant hyperthermia, CPB issues), remaining 4 transplanted hearts were successfully weaned off cardio-pulmonary bypass (CPB) on low dose inotropes. These hearts supported circulation (t=3 hrs) with good biventricular function.
Conclusions
The Transmedics OCS provides an excellent platform to assess DCD heart recovery following warm ischemia. Using a clinically applicable model, we have shown that DCD hearts with WIT ≤30 mins appear to be a viable source of additional organs in cardiac transplantation and warrant human studies.
Article info
Identification
Copyright
© 2013 Published by Elsevier Inc.
00998-4&id=gr1.jpg){kind=link}