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Initial Experience with Normothermic Ex-vivo Lung Perfusion for Donor Organ Preservation, Assessment and Reconditioning
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assist devices improve survival and enhance quality of life, the relatively frequent occurrence of adverse events (bleeding, infection, right ventricular failure, aortic incompetence, pump thrombosis and stroke), the substantial cost of the device and the need for frequent follow-up, these devices remain a relatively expensive intervention compared with costs associated with heart failure therapy. The key to rebalancing the cost effectiveness equation will involve addressing mitigation of adverse events after ventricular assist device implantation, improving the technology (such as transcutaneous energy transfer and pulsatility) and reducing the cost of the device. http://dx.doi.org/10.1016/j.hlc.2015.12.017 SCIENTIFIC SESSION 8: HEART FAILURE AND TRANSPLANTATION 18th Nov (WED) 10:10 - 10:20 Ex-Vivo Perfusion of Marginal Donor Hearts: Is normal allograft function assured post-transplant? Mark Connellan *, Hong Chew, Arjun Iyer, Emily Granger, Paul Jansz, Phillip Spratt, Peter Macdonald, Kumud Dhital St Vincent’s Hospital, Sydney, NSW, Australia The utilisation of marginal donor hearts for cardiac transplantation is becoming a more common practice worldwide. The complexity of cardiac recipients is however also increasing (50% of current waitlist on mechanical circulatory support) and so the need to assure good function of the transplanted heart is becoming even more important. We review our experience and outcomes using the TransMedics Organ Care System (OCS) to assess marginal donor hearts prior to transplantation. Seven marginal hearts from brain dead (BD) and five from donation after circulatory death (DCD) donors were retrieved between October 2012 and December 2014. None of the brain dead (BD) donor hearts were accepted for standard cold storage retrieval, having either an ejection fraction (EF) <50%, an interventricular septum > 12 mm and/or requirement for noradrenaline >0.2ug/kg/min. All donation after circulatory death (DCD) donor hearts were considered marginal. Three hearts (2 BD and 1 DCD) did not demonstrate satisfactory function on the OCS and were not transplanted. Nine marginal hearts were transplanted with no early mortality and all demonstrated normal ventricular function (EF 64 3%) 9 5 days postoperatively. One patient died 9 months post-transplant having experienced intractable rejection after medication non-compliance, and one infection related late death occurred over a follow-up period of 318 168 days. Echocardiography at 122 76 days demonstrated a normal ejection fraction in the remaining 7 recipients (EF 61 6%). Exvivo donor heart perfusion on the OCS has allowed us to utilise marginal heart donors in a reproducible manner with subsequent recovery of allograft function in all patients. http://dx.doi.org/10.1016/j.hlc.2015.12.018
Abstracts
SCIENTIFIC SESSION 8: HEART FAILURE AND TRANSPLANTATION 18th Nov (WED) 10:20 - 10:30 Initial Experience with Normothermic Ex-vivo Lung Perfusion for Donor Organ Preservation, Assessment and Reconditioning Emily Granger *, Kumud Dhital, Allan Glanville, Paul Jansz, Phillip Spratt St Vincent’s Hospital, Sydney, NSW, Australia In the local environment of static organ donation rates and expanding lung transplant waitlists, ex-vivo lung perfusion has been developed as a strategy to increase the donor pool by identifying “marginal” donors with the potential to recover. Furthermore, perfusion systems have changed the concept of donor organ preservation: it is now possible to have ongoing assessment of “viable” grafts during the transport time period previously associated with cold storage. Ex-vivo donor lungs can be further optimised using accepted interventions such as bronchoscopy, targetted ventilatory management, and medically “repaired” with antibiotics, steroids and possibly anti-inflammatory agents. This presentation will review the initial experience with the TransMedics Organ Care System (OCS) at St Vincents Hospital Sydney. The OCS is a transportable normothermic ex-vivo lung perfusion device. The program commenced January 2013 and participated in 2 trials: INSPIRE, international, randomised multicentre trial to compare OCS Lung preservation with cold storage; Marginal Lung Study, a local centre specific program evaluating the safety and effectiveness of the OCSTM Lung to recruit, preserve and assess donor lungs that do not meet current donor lung acceptance criteria. The technique for retrieval, placement on the ex-vivo apparatus and protocol for lung perfusion will be discussed. The OCS has allowed donor lungs to be reliably assessed, optimised and safely transported. Initial results are very promising and provide a good platform for reconditioning the marginal donor lung. Results even suggest that we should be rethinking traditional concepts of cold storage. Can we make what is good even better? http://dx.doi.org/10.1016/j.hlc.2015.12.019 SCIENTIFIC SESSION 8: HEART FAILURE AND TRANSPLANTATION 18th Nov (WED) 10:00 - 10:10 The Functional and Cellular Outcomes after Reanimation using Custodiol, Adenocaine or St Thomas’ Preservation (FORECAST) Ben Dunne *, Anthea Raisis, Kwok Ho, Chris Lee, Warren Pavey Fiona Stanley Hospital, Perth, WA, Australia
assist devices improve survival and enhance quality of life, the relatively frequent occurrence of adverse events (bleeding, infection, right ventricular failure, aortic incompetence, pump thrombosis and stroke), the substantial cost of the device and the need for frequent follow-up, these devices remain a relatively expensive intervention compared with costs associated with heart failure therapy. The key to rebalancing the cost effectiveness equation will involve addressing mitigation of adverse events after ventricular assist device implantation, improving the technology (such as transcutaneous energy transfer and pulsatility) and reducing the cost of the device. http://dx.doi.org/10.1016/j.hlc.2015.12.017 SCIENTIFIC SESSION 8: HEART FAILURE AND TRANSPLANTATION 18th Nov (WED) 10:10 - 10:20 Ex-Vivo Perfusion of Marginal Donor Hearts: Is normal allograft function assured post-transplant? Mark Connellan *, Hong Chew, Arjun Iyer, Emily Granger, Paul Jansz, Phillip Spratt, Peter Macdonald, Kumud Dhital St Vincent’s Hospital, Sydney, NSW, Australia The utilisation of marginal donor hearts for cardiac transplantation is becoming a more common practice worldwide. The complexity of cardiac recipients is however also increasing (50% of current waitlist on mechanical circulatory support) and so the need to assure good function of the transplanted heart is becoming even more important. We review our experience and outcomes using the TransMedics Organ Care System (OCS) to assess marginal donor hearts prior to transplantation. Seven marginal hearts from brain dead (BD) and five from donation after circulatory death (DCD) donors were retrieved between October 2012 and December 2014. None of the brain dead (BD) donor hearts were accepted for standard cold storage retrieval, having either an ejection fraction (EF) <50%, an interventricular septum > 12 mm and/or requirement for noradrenaline >0.2ug/kg/min. All donation after circulatory death (DCD) donor hearts were considered marginal. Three hearts (2 BD and 1 DCD) did not demonstrate satisfactory function on the OCS and were not transplanted. Nine marginal hearts were transplanted with no early mortality and all demonstrated normal ventricular function (EF 64 3%) 9 5 days postoperatively. One patient died 9 months post-transplant having experienced intractable rejection after medication non-compliance, and one infection related late death occurred over a follow-up period of 318 168 days. Echocardiography at 122 76 days demonstrated a normal ejection fraction in the remaining 7 recipients (EF 61 6%). Exvivo donor heart perfusion on the OCS has allowed us to utilise marginal heart donors in a reproducible manner with subsequent recovery of allograft function in all patients. http://dx.doi.org/10.1016/j.hlc.2015.12.018
Abstracts
SCIENTIFIC SESSION 8: HEART FAILURE AND TRANSPLANTATION 18th Nov (WED) 10:20 - 10:30 Initial Experience with Normothermic Ex-vivo Lung Perfusion for Donor Organ Preservation, Assessment and Reconditioning Emily Granger *, Kumud Dhital, Allan Glanville, Paul Jansz, Phillip Spratt St Vincent’s Hospital, Sydney, NSW, Australia In the local environment of static organ donation rates and expanding lung transplant waitlists, ex-vivo lung perfusion has been developed as a strategy to increase the donor pool by identifying “marginal” donors with the potential to recover. Furthermore, perfusion systems have changed the concept of donor organ preservation: it is now possible to have ongoing assessment of “viable” grafts during the transport time period previously associated with cold storage. Ex-vivo donor lungs can be further optimised using accepted interventions such as bronchoscopy, targetted ventilatory management, and medically “repaired” with antibiotics, steroids and possibly anti-inflammatory agents. This presentation will review the initial experience with the TransMedics Organ Care System (OCS) at St Vincents Hospital Sydney. The OCS is a transportable normothermic ex-vivo lung perfusion device. The program commenced January 2013 and participated in 2 trials: INSPIRE, international, randomised multicentre trial to compare OCS Lung preservation with cold storage; Marginal Lung Study, a local centre specific program evaluating the safety and effectiveness of the OCSTM Lung to recruit, preserve and assess donor lungs that do not meet current donor lung acceptance criteria. The technique for retrieval, placement on the ex-vivo apparatus and protocol for lung perfusion will be discussed. The OCS has allowed donor lungs to be reliably assessed, optimised and safely transported. Initial results are very promising and provide a good platform for reconditioning the marginal donor lung. Results even suggest that we should be rethinking traditional concepts of cold storage. Can we make what is good even better? http://dx.doi.org/10.1016/j.hlc.2015.12.019 SCIENTIFIC SESSION 8: HEART FAILURE AND TRANSPLANTATION 18th Nov (WED) 10:00 - 10:10 The Functional and Cellular Outcomes after Reanimation using Custodiol, Adenocaine or St Thomas’ Preservation (FORECAST) Ben Dunne *, Anthea Raisis, Kwok Ho, Chris Lee, Warren Pavey Fiona Stanley Hospital, Perth, WA, Australia