Ex Vivo Allograft Perfusion for Complex Pediatric Heart Transplant Recipients

Fleck, Thilo; Ayala, Rafael; Kroll, Johannes; Siepe, Matthias; Schibilsky, David; Benk, Christoph; Maier, Sven; Reineker, Katja; Hoehn, René; Humburger, Frank; Beyersdorf, Friedhelm; Stiller, Brigitte

doi:10.1016/j.athoracsur.2020.12.025

Cited by 19 publications

(30 citation statements)

References 16 publications

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“…Nevertheless, the OCS has recently been used in pediatric HTx procedures with very promising results. 15,58 Fleck et al 15 reported on the use of OCS in 8 children, compared with receiving conventional transplantation in 13 children. They found no difference in survival or other secondary outcomes between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

Normothermic Ex Situ Heart Perfusion With the Organ Care System for Cardiac Transplantation: A Meta-analysis

et al. 2022

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Background. Heart transplantation (HTx) is, at present, the most effective therapy for end-stage heart failure patients; however, the number of patients on the waiting list is rising globally, further increasing the gap between demand and supply of donors for HTx. First studies using the Organ Care System (OCS) for normothermic machine perfusion show promising results yet are limited in sample size. This article presents a meta-analysis of heart donation either after brain death (OCS-DBD) or circulatory death (OCS-DCD) on using OCS versus static cold storage used for HTx. Methods. A systematic literature search was performed for articles discussing the use of normothermic ex situ heart perfusion in adult patients. Thirty-day survival outcomes were pooled, and odds ratios were calculated using random-effects models. Long-term survival was visualized with Kaplan-Meier curves, hazard ratios were calculated and pooled using fixed-effects models, and secondary outcomes were analyzed. Results. A total of 12 studies were included, with 741 patients undergoing HTx, of which 260 with the OCS (173 DBD and 87 DCD). No differences were found between the 3 groups for early and late survival outcomes or for secondary outcomes. Conclusions. OCS outcomes, for both DBD and DCD hearts, appeared similar as for static cold storage. Therefore, OCS is a safe and effective technique to enlarge the cardiac donor pool in both DBD and DCD, with additional benefits for long-distance transport and surgically complex procedures.

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Section: Discussionmentioning

confidence: 99%

Normothermic Ex Situ Heart Perfusion With the Organ Care System for Cardiac Transplantation: A Meta-analysis

et al. 2022

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“…Use of the OCS system has also been described for standard pediatric cardiac grafts in patients requiring complex concomitant procedures with the risk of prolonging ischemic times. Fleck and colleagues reviewed 8 children transplanted with grafts persevered using OCS compared with 13 children transplanted using static cold storage [ 64 ]. The incidence of primary graft failure, as well as the graft function and occurrence of any treated rejection at follow-up revealed no significant difference between the two groups.…”

Section: Current Methods Of Heart Preservationmentioning

confidence: 99%

Heart Donation and Preservation: Historical Perspectives, Current Technologies, and Future Directions

Hess

Ziegler

Kaczorowski

2022

JCM

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Heart transplantation has become the accepted treatment for advanced heart failure, with over 4000–5000 performed in the world annually. Although the number of yearly transplants performed has been increasing over the last decade, the number of candidates in need of transplantation continues to grow at an even faster rate. To distribute these scarce and precious resources equitably, donor heart placement is based on clinical need with priority given to those who are more critically ill. As a result, donors are matched with recipient candidates over increasingly farther distances, which may subject these organs to longer ischemic times. One of the mainstays of successful heart transplantation is successful organ preservation while the donor organ is ex vivo from the time of donor procurement to recipient implantation. In order to adapt to a new era of heart transplantation where organs are shared across wider ranges, preservation strategies must evolve to accommodate longer ischemia times while mitigating the harmful sequalae of ischemia-reperfusion injury. Additionally, in order to address the ever-growing supply demand mismatch of donor organs, evolving perfusion technologies may allow for further evaluation of donor grafts outside of conventional acceptance practices, thus enlarging the effective donor pool. Herein this review, we discuss the history of organ preservation, current strategies and modalities employed in current practice, along with developing technologies in preclinical stages. Lastly, we introduce the concept of donation after circulatory death (DCD), which has been until recently a largely unexplored avenue of heart donation that relies much on current preservation techniques.

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“…The OCS system becomes a savior in these situations, and surgeons can perform more peaceful and conscious mediastinal dissection [27]. Fleck et al in their study found that pediatric transplant patients had better outcomes when the donor heart was perfused with OCS than those in which SCS was used [33]. A small retrospective study by Ardehali et al reported that the use of OCS before heart transplant in patients with VAD had better 30-day survivability when compared to SCS [31].…”

Section: Advantagesmentioning

confidence: 99%

Is the Organ Care System (OCS) Still the First Choice With Emerging New Strategies for Donation After Circulatory Death (DCD) in Heart Transplant?

Alomari¹,

Garg²,

Yazji³

et al. 2022

Cureus

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The scarcity of donor hearts continues to be a challenge in transplants for advanced heart failure patients. With an increasing number of patients on the waiting list for a heart transplant, the discrepancy in the number between donors and recipients is gradually increasing and poses a new challenge that plagues the healthcare systems when it comes to the heart. Several technologies have been developed to expand the donor pool in recent years. One such method is the organ care system (OCS). The standard method of organ preservation is the static cold storage (SCS) method which allows up to four hours of safe preservation of the heart. However, beyond four hours of cold ischemia, the incidence of primary graft dysfunction increases significantly. OCS keeps the heart perfused close to the physiological state beyond the four hours with superior results, which allows us to travel further and longer distances, leading to expansion in the donor pool. In this review, we discuss the OCS system, its advantages, and shortcomings.

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Ex Vivo Allograft Perfusion for Complex Pediatric Heart Transplant Recipients

Cited by 19 publications

References 16 publications

Normothermic Ex Situ Heart Perfusion With the Organ Care System for Cardiac Transplantation: A Meta-analysis

Normothermic Ex Situ Heart Perfusion With the Organ Care System for Cardiac Transplantation: A Meta-analysis

Heart Donation and Preservation: Historical Perspectives, Current Technologies, and Future Directions

Is the Organ Care System (OCS) Still the First Choice With Emerging New Strategies for Donation After Circulatory Death (DCD) in Heart Transplant?

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