DCD Heart Transplantation using Normothermic Regional Perfusion (NRP) after Very Long Warm Ischemic Time: Early Single Center Experience
Presented During:
Friday, September 20, 2024: 5:00PM - 6:30PM
Omni King Edward Hotel
Abstract No:
10142
Submission Type:
Abstract Submission
Authors:
Matteo Marro (1), Massimo Boffini (2), Erika Simonato (2), Marinella Zanierato (2), Rocco Gabriele Sorace (2), Antonio Loforte (2), Andrea Costamagna (2), Marco Ellena (2), Anna Chiara Trompeo (2), Mauro Rinaldi (2)
Institutions:
(1) Torino University Hospital, Turin, Turin, (2) Torino University Hospital, Turin, NA
Submitting Author:
Matteo Marro
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Torino University Hospital
Torino University Hospital
Co-Author(s):
Massimo Boffini
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Torino University Hospital
Torino University Hospital
Erika Simonato
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Torino University Hospital
Torino University Hospital
Marinella Zanierato
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Torino University Hospital
Torino University Hospital
Rocco Gabriele Sorace
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Torino University Hospital
Torino University Hospital
Antonio Loforte
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Torino University Hospital
Torino University Hospital
Andrea Costamagna
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Torino University Hospital
Torino University Hospital
Marco Ellena
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Torino University Hospital
Torino University Hospital
Anna Chiara Trompeo
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Torino University Hospital
Torino University Hospital
Mauro Rinaldi
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Torino University Hospital
Torino University Hospital
Presenting Author:
Matteo Marro
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Abstract:
Objective. Heart transplantation (HTx) in the setting of organ donation after circulatory death (DCD) is increasing worldwide with encouraging clinical results. However, heart grafts are exposed to a phase of warm ischemic time (WIT) that may produce a significant detrimental injury, especially in older donors. Aim of the present study is to evaluate the preliminary results of DCD HTx performed in our center with DCD donation on site and a WIT longer than 30 minutes.
Methods. Since the beginning of a DCD HTx protocol in July 2023, based on Thoraco-Abdominal Normothermic Regional Perfusion (NRP) and cold static storage (CS), seven heart donors (5 males/2 females, mean age 50.6±4.8 years) became available in our hospital after a mean ICU stay of 18±6 days. After the withdrawal of life sustaining therapies in the operative room, the agonal phase started after 4.1±2.1 min. Mean functional WIT (calculated from the falling of the systolic pressure below 50 mmHg and/or Oxygen Saturation below 70% till the start of NRP) and WIT were 39.4±4 min and 43.6±3.3 min, respectively. During the reperfusion time, blood test were conducted every hour to monitor trend of lactate, creatine phosphokinase-MB (CK-MB), troponin I, myoglobin. NRP was weaned after a mean time of 99.9±16.1 min and after a mean period (206.6±43.15 min) of beating heart ("DBD-like" situation), the grafts were preserved with CS under blood cardioplegic arrest. Figure 1 shows the timeline of the procedure.
Results. Seven recipients (7males, mean age 60±5.4 years) received the DCD heart grafts. One patient was on the status 1 on inotropes i.v. and intra-aortic balloon pump and 1 patient was supported with an LVAD at the time of transplant. Mean cold ischemic time of the grafts was 87.3±9.1 min with blood cardioplegia flushing every nearly 15 minutes. Two patients required post-Tx VA-ECMO that were both successfully weaned after four days. Mean time of mechanical ventilation and intensive care unit stay were 18±63 hours and 5.4±3.7 days, respectively. Post-operative period was uneventful in all cases except in one recipient who required temporary renal replacement therapy. All patients were discharged from hospital after 25.6±9.6 days. At a mean follow-up of 169.4±132 days, they are all in NYHA Class I with optimal graft function (mean Ejection Fraction 57±5.1 %, Cardiac Index 2.9±0.4 l/min/mq, wedge pressure 6.3±2.5 mmHg). Two patients suffered from a grade 2R cellular acute rejection, one responsive to steroids i.v. therapy and one resistant, successfully treated with thymoglobuline infusion.
Conclusions. Despite prolonged WIT, mainly related to a very long "stand off" period due to our legislation for the declaration of death, our preliminary results show encouraging short-term outcomes of DCD HTx, even using quite old donors. A longer follow-up and a larger cohort of patients are mandatory to better confirm these data.
Methods. Since the beginning of a DCD HTx protocol in July 2023, based on Thoraco-Abdominal Normothermic Regional Perfusion (NRP) and cold static storage (CS), seven heart donors (5 males/2 females, mean age 50.6±4.8 years) became available in our hospital after a mean ICU stay of 18±6 days. After the withdrawal of life sustaining therapies in the operative room, the agonal phase started after 4.1±2.1 min. Mean functional WIT (calculated from the falling of the systolic pressure below 50 mmHg and/or Oxygen Saturation below 70% till the start of NRP) and WIT were 39.4±4 min and 43.6±3.3 min, respectively. During the reperfusion time, blood test were conducted every hour to monitor trend of lactate, creatine phosphokinase-MB (CK-MB), troponin I, myoglobin. NRP was weaned after a mean time of 99.9±16.1 min and after a mean period (206.6±43.15 min) of beating heart ("DBD-like" situation), the grafts were preserved with CS under blood cardioplegic arrest. Figure 1 shows the timeline of the procedure.
Results. Seven recipients (7males, mean age 60±5.4 years) received the DCD heart grafts. One patient was on the status 1 on inotropes i.v. and intra-aortic balloon pump and 1 patient was supported with an LVAD at the time of transplant. Mean cold ischemic time of the grafts was 87.3±9.1 min with blood cardioplegia flushing every nearly 15 minutes. Two patients required post-Tx VA-ECMO that were both successfully weaned after four days. Mean time of mechanical ventilation and intensive care unit stay were 18±63 hours and 5.4±3.7 days, respectively. Post-operative period was uneventful in all cases except in one recipient who required temporary renal replacement therapy. All patients were discharged from hospital after 25.6±9.6 days. At a mean follow-up of 169.4±132 days, they are all in NYHA Class I with optimal graft function (mean Ejection Fraction 57±5.1 %, Cardiac Index 2.9±0.4 l/min/mq, wedge pressure 6.3±2.5 mmHg). Two patients suffered from a grade 2R cellular acute rejection, one responsive to steroids i.v. therapy and one resistant, successfully treated with thymoglobuline infusion.
Conclusions. Despite prolonged WIT, mainly related to a very long "stand off" period due to our legislation for the declaration of death, our preliminary results show encouraging short-term outcomes of DCD HTx, even using quite old donors. A longer follow-up and a larger cohort of patients are mandatory to better confirm these data.
Mechanical Support and Thoracic Transplantation Summit:
Heart Transplant
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