García Sáez Diana, Zych Bartlomiej, Sabashnikov Anton, Bowles Christopher T, De Robertis Fabio, Mohite Prashant N, Popov Aron-Frederik, Maunz Olaf, Patil Nikhil P, Weymann Alexander, Pitt Timothy, McBrearty Louise, Pates Bradley, Hards Rachel, Amrani Mohamed, Bahrami Toufan, Banner Nicholas R, Simon Andre R
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Ann Thorac Surg. 2014 Dec;98(6):2099-105; discussion 2105-6. doi: 10.1016/j.athoracsur.2014.06.098. Epub 2014 Oct 23.
A severe shortage of available donor organs has created an impetus to use extended criteria organs for heart transplantation. Although such attempts increase donor organ availability, they may result in an adverse donor-recipient risk profile. The TransMedics Organ Care System (OCS) (TransMedics, Inc, Boston) allows preservation of the donor heart by perfusing the organ at 34°C in a beating state, potentially reducing the detrimental effect of cold storage and providing additional assessment options. We describe a single-center experience with the OCS in high-risk heart transplant procedures.
Thirty hearts were preserved using the OCS between February 2013 and January 2014, 26 of which (86.7%) were transplanted. Procedures were classified as high risk based on (1) donor factors, ie, transport time more than 2.5 hours with estimated ischemic time longer than 4 hours, left ventricular ejection fraction (LVEF) less than 50%, left ventricular hypertrophy (LVH), donor cardiac arrest, alcohol/drug abuse, coronary artery disease or (2) recipient factors, ie, mechanical circulatory support or elevated pulmonary vascular resistance (PVR), or both.
Donor and recipient age was 37 ± 12 years and 43 ± 13 years, respectively. Allograft cold ischemia time was 85 ± 17 minutes and OCS perfusion time was 284 ± 90 minutes. The median intensive care unit stay was 6 days. One death (3.8%) was observed over the follow-up: 257 ± 116 (109-445 days). There was preserved allograft function in 92% of patients, with a mean LVEF of 64% ± 5%.
Use of the OCS is associated with markedly improved short-term outcomes and transplant activity by allowing use of organs previously not considered suitable for transplantation or selection of higher risk recipients, or both.
可用供体器官的严重短缺促使人们在心脏移植中使用边缘供体器官。尽管这种尝试增加了供体器官的可用性，但可能会导致供体 - 受体风险状况不佳。TransMedics器官护理系统（OCS）（TransMedics公司，波士顿）可通过在34°C下以跳动状态灌注器官来保存供体心脏，这可能会降低冷藏的有害影响并提供额外的评估选项。我们描述了在高风险心脏移植手术中使用OCS的单中心经验。
2013年2月至2014年1月期间，使用OCS保存了30颗心脏，其中26颗（86.7%）进行了移植。根据以下情况将手术分类为高风险：（1）供体因素，即转运时间超过2.5小时且估计缺血时间超过4小时、左心室射血分数（LVEF）低于50%、左心室肥厚（LVH）、供体心脏骤停、酒精/药物滥用、冠状动脉疾病；或（2）受体因素，即机械循环支持或肺血管阻力（PVR）升高，或两者皆有。
供体和受体的年龄分别为37±12岁和43±13岁。同种异体移植物冷缺血时间为85±17分钟，OCS灌注时间为284±90分钟。重症监护病房的中位住院时间为6天。在随访期间观察到1例死亡（3.8%）：随访时间为257±116（109 - 445天）。92%的患者同种异体移植物功能得以保留，平均LVEF为64%±5%。
通过允许使用以前被认为不适合移植的器官或选择更高风险的受体，或两者兼而有之，使用OCS与显著改善短期结果和移植活动相关。
