Cardiac transport system confers less graft dysfunction vs. ice storage
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Key takeaways:
- For extended-criteria donor hearts, a cardiac transport system was associated with better posttransplant outcomes than conventional ice storage.
- There was no difference between the groups in survival.
A cardiac transport system was better than conventional ice storage at preventing primary graft dysfunction in recipients implanted with extended-criteria donor hearts, researchers reported.
The researchers analyzed 308 patients from the GUARDIAN-Heart Registry (mean age, 55 years) who received extended-criteria donor hearts, defined as hearts from donors older than 60 years or older than 50 years with two of the following: high BP, elevated creatinine or death from stroke. They compared those transplanted with extended-criteria donor hearts transported with the cardiac transport system (SherpaPak, Paragonix) to those transplanted with extended-criteria donor hearts transported with conventional ice storage. The results were presented at the International Society for Heart & Lung Transplantation Annual Meeting & Scientific Sessions and published in The Journal of Heart and Lung Transplantation.
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The cardiac transport system “uses innovative phase-change material panels to provide a stable 4°C to 8°C environment for up to 40 hours with no external power source,” Roxana Moayedifar, MD, cardiothoracic surgeon at the Medical University of Vienna, told Healio. “It consists of an outer transport shipper, an inner and outer hard-shell assembly that provides a double, rigid barrier shipper in which the organ is immersed and suspended in a cold storage fluid cleared for use in storing and transporting donor organs, a temperature data logger that monitors and displays the temperature of the organ during transport, and a timer that displays elapsed time during transport. It is important to note that the SherpaPak does not perfuse the heart and provides even cooling with no direct surface contact of the donor organ and no temperature gradients. This is in contrast to the conventional method of utilizing ice storage, in which the donor organ is placed into a plastic bag and immersed in a cold storage solution, enclosed within two more plastic bags filled with cold saline, and finally placed on crushed ice.”
A previous study showed that the cardiac transport system reduced need for posttransplant mechanical circulatory support and severe primary graft dysfunction in standard-criteria donor hearts compared with conventional ice storage, so the researchers wanted to determine if the same would be true with extended-criteria donor hearts, Moayedifar told Healio.
Compared with the ice storage group, the SherpaPak group had less severe primary graft dysfunction (6.3% vs. 13.6%; P = .03), less primary graft dysfunction of any severity (13.1% vs. 22.7%; P = .026), less need for mechanical circulatory support after transplantation (20.5% vs. 36.4%; P = .002) and a lower rate of new ventricular assist device or extracorporeal membrane oxygenation after transplantation (8% vs. 15.9%; P = .03), according to the researchers.
“The SherpaPak is superior to ice storage in the preservation and recovery of extended-criteria donors and can be safely utilized for heart preservation during the transportation of these organs,” Moayedifar told Healio. “This is a particularly relevant application given the need for the donor pool to keep pace with the demand for heart transplants. It provides a simple and cost-effective solution to safely increase donor heart utilization while minimizing adverse posttransplant events.”
Survival rates in the hospital, at 30 days and at 1 year were similar between the groups, with 91.2% of the SherpaPak group and 88.6% of the ice storage group surviving at 1 year.
“From the view of a transplant surgeon, having the choice of implanting a well-preserved, cooled, yet still very elastic donor heart from the SherpaPak is a whole different world compared to a stiff, rigid and sometimes partly frozen organ from conventional ice storage,” Moayedifar told Healio. “Based on our experience with the SherpaPak, I can say with confidence that compared to conventional ice storage, the SherpaPak is our preferred method of donor heart preservation.”
Reference:
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Moayedifar R, et al. Abstract 50. Presented at: International Society for Heart & Lung Transplantation Annual Meeting & Scientific Sessions; April 19-22, 2023; Denver.
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