This publication presents a retrospective analysis of heart transplants that occurred at St Vincent’s Hospital, Sydney, from January 2021 to February 2024, with focus on different preservation strategies and recipient outcomes such as severe primary graft dysfunction (sPGD) and mortality.
Heart transplants were categorized into three groups:
- DCD-NMP (n=44): heart transplants from DCD donors, perfused utilizing normothermic machine perfusion (NMP) with Transmedics OCS Heart;
- DBD-HOPE (n=38): hearts transplanted from DBD donors and perfused utilizing hypothermic oxygenated perfusion (HOPE) with the XVIVO XHAT device. XHAT was used if the anticipated donor ischemic time exceeded 6 hours either due to donor location, transport time and/or recipient complexity;
- DBD-SCS (n=78): heart transplants from DBD donors preserved utilizing traditional static cold storage (SCS).
The donor preservation time in the DBD-HOPE group was significantly longer than the donor ischemic time in the DBD-SCS group, and the OCS run time in the DCD-NMP group (361±89 vs. 208±47 and 249±49 min respectively, P<0.001). Not only is this indicative of utilization of HOPE for long distance procurement, it is also a by-product of implanting teams being able to select increasingly complex recipients. This can be reflected as the DBD-HOPE group was significantly more likely to have recipients requiring a re-do sternotomy at the time of transplant (66% compared to 39% and 36% respectively, P=0.0075), as well as significantly longer cardiopulmonary bypass and cross clamp times when compared to the other two groups.
Despite the increased recipient complexity and mean preservation time exceeding 6 hours in the DBD-HOPE group, there was no significant difference between all groups in: survival, rates of sPGD, length of hospital stay or incidence of permanent stroke.
The rates of sPGD requiring extracorporeal membrane oxygenation (ECMO) in the DCD-NMP, DBDHOPE and DBD-SCS groups were 7%, 5% and 5% respectively, P=0.9.
For the groups DCD-NMP, DBD-HOPE and DBD-SCS respectively: 30-day survival was 100%, 97% and 100%; 1-year survival was: 94%, 90% and 94%; and 2-year survival was: 90%, 90% and 89% (P=0.9).
“For BD donors, [HOPE] allows for donor hearts to be preserved significantly longer than SCS with no differences in survival or sPGD. “
Joshi et al, 2024
Ann Cardiothorac Surg / 2024 / 2304-1021
Product used in this clinical trial was XVIVO Heart Assist Transport™
The XVIVO Heart Technology is not regulatory approved on any market and its safety and efficacy has not been established.
The XVIVO Heart Technology is not commercially available.
