CARD9: Ex-vivo Heart Perfusion Using Organ Care System for Cardiac Transplantation: A Single Center Experience in the United States

Background: The Organ Care System (OCS) (Transmedics, Andover, MA) for ex vivo organ perfusion of the heart has enabled significant extension of ex situ intervals. OCS can minimize cold ischemic time, allowing for an expansion of the limited donor pool to include extended distances. As the use of OCS for donor recovery after brain death (DBD) in the United States is lacking, we report our initial experience. Methods: We reviewed consecutive DBD heart transplant (HT) patients at our center from May 2022 (FDA approval) to January 2023. Patients were stratified into two groups: OCS (N=10) vs. Conventional cold storage (Control, N=16). The indication for OCS use was an expected ischemic time >4 hours. Results: Baseline characteristics were similar (Table 1). The OCS group displayed a significantly greater distance traveled for heart recovery (OCS, 764±352 vs Control, 207±176 miles, p <0.001), in addition to mean total preservation time (6.2±0.9 vs 2.6±0.6, p<0.001) (Figure 1). No patients in the OCS group required new veno-arterial extracorporeal membrane oxygenation support (0% vs 7.7%, p=0.32). Primary graft dysfunction was comparable in both groups (OCS 10% vs Control 18.7%, p=0.55). Mortality was lower in the OCS group, with 100% in-hospital survival compared to 93.7% in conventional group (p=0.21). Conclusion: Our short-term results of the use of OCS for DBD recovery were favorable. Given our mean preservation time of approximately 7 hours and distance traveled of >700 miles, OCS can safely augment the number and viability of available organs without compromising the outcome.Figure 1. Total preservation time and cold ischemic time in OCS and conventional procurement groups