Twenty-four–hour hypothermic oxygenated perfusion preserves graft viability in a porcine donation after circulatory death and donation after brain death heart transplant model

Abstract

Background Heart transplantation using standard static cold storage is associated with an increased risk of organ injury if the cold ischemic time exceeds 4 to 5 hours. The present study investigated an innovative approach using hypothermic oxygenated perfusion (HOPE) to extend preservation time to 24 hours and assessed its impact on posttransplant graft function. Methods This study assessed graft efficacy based on a single preservation strategy across 2 donor types as follows: (1) donation after circulatory death (DCD) (n = 8) and (2) donation after brain death (DBD) (n = 8), both followed by direct procurement and 24 hours of HOPE before transplantation. After weaning from cardiopulmonary bypass (CPB), biventricular function was assessed using biventricular pressure–volume loops and pulmonary artery catheters during a 2-hour observation period. Results All included transplantations were successfully weaned from CPB and achieved comparable and adequate cardiac outputs (DCD: 5.0 ± 0.56 L/min, DBD 4.5 ± 0.21 L/min, p = 0.14). Both left (LV) and right ventricular (RV) myocardial contractility were preserved; LV end-systole elastance (Ees) was significantly higher after transplantation compared to baseline ( p <0.001), whereas RV Ees showed no significant change over time ( p = 0.08). No primary graft dysfunction occurred during the observation period. Conclusion Twenty-four hours of HOPE preservation ensured preserved graft viability after both DCD and DBD heart transplantation in a porcine model. Our results suggest a potential to significantly extend preservation time in clinical heart transplantation.