Improving Donor Organ Preservation
Cristina Sanchez Torralvo, Jose Ramón Echevarría Uribarri, Lucía Pañeda Delgado, Barbara Segura Méndez, Eduardo Velasco García, Nuria Arce Ramos, Yolanda Carrascal Hinojal, Mireia Fernández Gutiérrez, Salvatore Di Stefano, Juan Bustamante Munguira
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Objective: Limited availability of donor hearts and older ages in donors are two problems we face in cardiac transplant. Having to travel long distances in order to retrieve a heart can prolong the ischemic period. Our aim was to improve cardiac transplant outcomes trough improving preservation conditions. Methods: Since January 2020, we have introduced a new transport system that claims to avoid mechanical and cold injury due to its design. After standard cardiac extraction, the organ is suspended in a recipient full of preservation fluid at 4ÂºC, hanging from the aorta in order to avoid contact with any surface. The recipient is then stored in an isolation capsule. Temperature and pressure inside the recipient are continuously monitored. Results: 8 transplants were performed using this preservation method. Mean temperature during transport was 5,6Âº, no apparent mechanical or cold injury. Mean ischemic period was 3.15 hours. Incidence of primary graft dysfunction was brought from 55% to 25% since application of the system. In the ICU, inotropic drug requirements have been reduced in dosage and duration (from 2+ weeks to a mean duration of 6 days). At 8 months of follow up, 5 of 8 patients are discharged home with no complications. Conclusions: This new transportation system improves control over the state of the organ during transportation with continuous monitoring. It might be a useful tool to reduce incidence of primary graft dysfunction. It could even promote transplant of hearts with longer ischemic periods since the system provides evidence of optimal preservation conditions.
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