Twenty-four–hour hypothermic oxygenated perfusion preserves graft viability in a porcine donation after circulatory death and donation after brain death heart transplant model

BACKGROUND: Heart transplantation using standard static cold storage is associated with an increased risk of organ injury if the cold ischemic time exceeds 4 to 5 hours. The present study investigated an innovative approach using hypothermic oxygenated perfusion (HOPE) to extend preservation time to 24 hours and assessed its impact on posttransplant graft function. METHODS: This study assessed graft efficacy based on a single preservation strategy across 2 donor types as follows: (1) donation after circulatory death (DCD) (n = 8) and (2) donation after brain death (DBD) (n = 8), both followed by direct procurement and 24 hours of HOPE before transplantation. After weaning from cardiopulmonary bypass (CPB), biventricular function was assessed using biventricular pressure-volume loops and pulmonary artery catheters during a 2-hour observation period. RESULTS: All included transplantations were successfully weaned from CPB and achieved comparable and adequate cardiac outputs (DCD: 5.0 ± 0.56L/min, DBD 4.5 ± 0.21L/min, p = 0.14). Both left (LV) and right ventricular (RV) myocardial contractility were preserved; LV end-systole elastance (Ees) was significantly higher after transplantation compared to baseline (p<0.001), whereas RV Ees showed no significant change over time (p = 0.08). No primary graft dysfunction occurred during the observation period. CONCLUSION: Twenty-four hours of HOPE preservation ensured preserved graft viability after both DCD and DBD heart transplantation in a porcine model. Our results suggest a potential to significantly extend preservation time in clinical heart transplantation.