D. García Sáez

Utilization of the Organ Care System Lung for the assessment of lungs from a donor after cardiac death (DCD) before bilateral transplantation

In this manuscript, we present the first experience of evaluating donation after circulatory death (DCD) lungs, using the normothermic preservation Organ Care System (OCS) and subsequent successful transplantation. The OCS could be a useful tool for the evaluation of marginal lungs from DCD donors as it allows a proper recruitment and bronchoscopy in such donations in addition to continuous ex-vivo perfusion and assessment and treatment during transport. The OCS could potentially be a standard of care in the evaluation of marginal lungs from DCD.

Outcomes in Patients Receiving HeartMate II Versus HVAD Left Ventricular Assist Device as a Bridge to Transplantation

OBJECTIVE Ventricular assist devices have become a standard treatment for patients with advanced heart failure. We present data comparing results after implantation of HeartMate II (HM II) versus HVAD (HW) left ventricular assist devices (LVADs) for the past 7 years at our institution. METHODS From July 2006 to August 2012, 121 consecutive patients underwent LVAD implantation: 70 (57.9%) received HM II and 51 (42.1%) HW. Patient demographics, perioperative characteristics, and laboratory parameters as well as postoperative outcome were compared retrospectively. RESULTS Patients in the HM II group were significantly younger (P < .01), with more deranged liver function (higher bilirubin [P = .02] and alanine aminotransferase [P = .01] levels), and had a significantly higher rate of preoperative infections requiring antibiotic treatment (P = .02) and a higher body core temperature (P < .01). Other demographic and preoperative parameters did not show statistical differences. Most postoperative characteristics were also similar between the two groups. HM II patients had a significantly higher transfusion rate, but there were no differences in incidence of resternotomy (P = .156). Recovery and VAD explantation were more likely in the HM II group (P = .02). Although there was no significant difference in survival (log rank test: P = .986; Breslow test: P = .827), HM II patients were more likely to develop a percutaneous site infection (P = .01). CONCLUSIONS Both HM II and HW provide similar early postoperative outcome and good long-term survival. The differences observed between the groups may be related to demographic and preoperative factors rather than the type of the device used.

First Expierence in Heart Transplantation with Organs Procured after Cardio-Circulatory Death in a Porcine Model. Is the Organ Care System the Long Awaited Solution?

Objectives: Donation after cardiac death (DCD) has lead to an increase in organ availability. For obvious reasons, DCD hearts could not be used for transplantation. Several scenarios have been suggested in which DCD hearts could be used, most involving the re-establishing of blood flow within the donor by a variety of means. This leads to enormous ethical challenges based on the physiological situation within the donor. We propose to procure the heart alongside the other organs in a standard manner followed by an ex vivo assessment and reconditioning using the Organ Care System (OCS). The OCS is a mobile unit which allows for preservation and transport of a continuously perfused, beating heart, thereby avoiding the effects of cold ischemic storage and providing further assessment options, which is used in clinical transplantation for extended criteria donors by us. Methods: The study protocol reflects the UKs current clinical DCD protocol and practice. 5 pigs were anaesthetized with isofluorane. No heparin was administered. Cardio circulatory death was induced by cessation of mechanical ventilation. Agonal time (AT) was calculated as the time between a reduction of blood pressure below 50 mm Hg or a fall in saturation beneath 70% and the cessation of electrical activity. After a further 15 minute. of warm ischemia, hearts were procured and implanted into the OCS, mimicking the actual clinical scenario for other organs. Thus procured grafts were reconditioned in the OCS and assessed over a period of 4 hour. Results: 4 hearts were successfully resuscitated in the system (AT 8, 15, 20 and 34 minute.) with an overall time from withdrawal to OCS perfusion (WtP) of 41, 50, 67and 79 minute., respectively. ¾ had excellent contractility and lactate trends and were considered to be transplantable. ¼ (AT 34 minute, WtP 79 minute.) had an increased lactate and abnormal contractility being unsuitable for transplantation. One heart with 48 minute. AT and a WtP of 90 minute. could not be resuscitated. Conclusions: Our data show that hearts from not heparinized, DCD donors can be successfully reconditioned using the OCS in a scenario simulating actual clinical conditions. Based on the results we plan to assess the model in a clinical DCD environment.