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Midterm Follow up of Heart Transplantation with Routine Ex-Vivo Normothermic Preservation with Adverse Donor - Recipient Risk Profile
... The OCS is the first commercially available device that preserves the heart in a beating, perfused, normothermic and oxygenated state and allows the surgeons to assess transplantability of "extended criteria" donor hearts. Utilization of this technology has allowed for successful transplantation of hearts with significant left ventricular hypertrophy, reduced left ventricular ejection fraction (LVEF), palpable coronary artery disease or predicted long cold ischemic times after ex-situ assessment (3). ...
... In order to achieve this, two concepts of reperfusing a DCD heart prior to transplantation are utilized; one technique entails in-situ normothermic regional perfusion (NRP) of the donor following circulatory death, who is placed in central extracorporeal life support (3). For that purpose, cannulae are inserted into the ascending aorta and right atrium with cerebral exclusion by clamping neck vessels, before restoring perfusion. ...
Fifty years after the first successful heart transplantation, despite multiple advances in the treatment of advanced acute and chronic heart failure, there is still no equivalent to heart transplantation as a long-term treatment for end-stage heart failure. Transplantation is, however, limited by the scarcity and quality of heart allografts. Donors are nowadays significantly older, particularly in European countries, and traumatic head injury as the cause of death has been replaced by intracerebral hemorrhage or hypoxic brain damage in the majority of cases. In addition, many donors have undergone extensive resuscitation efforts. Recipient characteristics have progressively changed too within the last couple of decades; recipients are older, often with comorbidities and nearly half of them are bridged to transplant with a wide variety of mechanical circulatory support devices. These developments have resulted in heart transplant surgery becoming significantly more challenging with longer more complex surgery and increased ischemia times for organs that were previously considered to be borderline or non-transplantable in many cases. To address this, several options have been explored within the last years and as a result, novel strategies have been developed and tested in order to optimize graft preservation and potentially increase the donor pool. The two notable developments are the ability to procure hearts from donors after circulatory death and the advent of ex-vivo perfusion of hearts. This technology has made the transplantation of extended criteria organs, including those from circulatory determined death (DCD) donors possible, and allow for out of body time of more than 12 hours in heart transplantation. In this review, we set out the basis of the current practices in organ procurement, and the opportunities for the future as demands for organ transplantation continue to increase.
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