Direct Procurement and Perfusion Using Hypothermic Oxygenated Perfusion for DCD Cardiac Allografts in North America

Abstract

BACKGROUND: Donation after circulatory death (DCD) is a viable avenue for recovery of cardiac allografts for transplantation. Previous methods have utilized direct procurement and perfusion (DPP) using commercially available normothermic perfusion systems or in situ normothermic regional perfusion. A novel portable hypothermic oxygenated perfusion device (HOPE) (XVIVO Perfusion) has been developed and is in clinical trials for preservation of cardiac allografts. Here, we report the first North American experience using a HOPE preservation device for DPP recovery of DCD cardiac allografts and detail our experience and early patient outcomes. METHODS: DCD cardiac allografts were procured and preserved using the HOPE platform and transported to our medical center for transplantation into awaiting recipients. Patient clinical course and outcomes are reported. Permission for this report was granted by the study sponsor and by our institutional review board. RESULTS: Five end-stage heart failure patients underwent orthotopic heart transplantation at our institution using DCD allografts preserved with the HOPE platform. Average preservation time was 298 min with no observed cases of severe primary graft dysfunction. One patient died because of multiple extracardiac complications, but with preserved allograft function, and 1 patient required mechanical circulatory support for secondary graft dysfunction. All patients surviving to discharge were alive at last follow-up. CONCLUSIONS: This early, limited, single-institution experience of DPP preservation of DCD cardiac allografts using a HOPE platform demonstrates early success in transplanting adequately functioning allografts with acceptable patient outcomes. Further study and experience with HOPE for DCD allografts is needed.