1
|
Weininger G, Choi AY, Joseph Woo Y, MacArthur JW. Successful heart transplants from over 2000 miles away. J Heart Lung Transplant 2024; 43:354-356. [PMID: 37479048 DOI: 10.1016/j.healun.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/06/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023] Open
Affiliation(s)
- Gabe Weininger
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ashley Y Choi
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
2
|
Hirani R, Okumura K, Isath A, Gregory V, Khan S, Dhand A, Lanier GM, Spielvogel D, Kai M, Ohira S. Utilization of hepatitis C virus infected donors in heart transplant recipients with elevated MELD-XI score. Clin Transplant 2023; 37:e15124. [PMID: 37688341 DOI: 10.1111/ctr.15124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The advent of direct-acting antivirals has helped to increase the safe utilization of organs from hepatitis C virus positive (HCV+) donors. However, the outcomes of heart transplantation (HT) using an HCV+ donor are unclear in recipients with underlying liver disease represented by an elevated model for end-stage liver disease excluding international normalized ratio (MELD-XI). METHODS The United Network of Organ Sharing database was queried from Jan 2016 to Dec 2021. Post-transplant outcomes stratified by recipient MELD-XI score (low <10.37, medium, 10.38-13.39, and high >13.4) was compared between patients with HT from HCV+ (N = 792) and patients with HT from HCV-negative donors (N = 15,266). RESULTS The median MELD-XI score was comparable (HCV+, 12.1, vs. HCV-negative, 11.8, p = .37). In the HCV+ group, donors were older (33 vs. 31 years, p < .001). Ischemic time of donor hearts (3.48 vs. 3.28 h, p < .001) and travel distance (250 vs. 157 miles, p < .001) were longer in HCV+ group. In the Kaplan Meier analysis with a median follow-up of 750 days, survival was comparable between the two groups (2-year survival, MELD-XI Low: HCV+, 92.4 ± 3.6% vs. HCV-negative, 91.1 ±.8%, p = .83, Medium: HCV+ 89.2 ± 4.3% vs. HCV-negative, 88.2 ± 1.0%, p = .68, and High: HCV+, 84.9 ± 4.5% vs. HCV-negative, 84.6 ± 1.1%, p = .75) In multivariate Cox hazard models, HCV donors were not associated with mortality in each MELD-XI subgroup (Low: adjusted hazard ratio (aHR), 1.02, p = .94; Medium: aHR, .95, p = .81; and High: aHR, .93, p = .68). CONCLUSION Utilization of HCV+ hearts was not associated with an increased risk of adverse outcomes in recipients with an elevated MELD- XI score.
Collapse
Affiliation(s)
- Rahim Hirani
- New York Medical College, Valhalla, New York, USA
| | - Kenji Okumura
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | | | - Shazli Khan
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Abhay Dhand
- Transplant Infectious Disease, Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Gregg M Lanier
- New York Medical College, Valhalla, New York, USA
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - David Spielvogel
- New York Medical College, Valhalla, New York, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Masashi Kai
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Suguru Ohira
- New York Medical College, Valhalla, New York, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| |
Collapse
|
3
|
Shudo Y, Leacche M, Copeland H, Silvestry S, Pham SM, Molina E, Schroder JN, Sciortino CM, Jacobs JP, Kawabori M, Meyer DM, Zuckermann A, D’Alessandro DA. A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System. ASAIO J 2023; 69:993-1000. [PMID: 37678260 PMCID: PMC10602216 DOI: 10.1097/mat.0000000000002036] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Traditional ice storage has been the historic standard for preserving donor's hearts. However, this approach provides variability in cooling, increasing risks of freezing injury. To date, no preservation technology has been reported to improve survival after transplantation. The Paragonix SherpaPak Cardiac Transport System (SCTS) is a controlled hypothermic technology clinically used since 2018. Real-world evidence on clinical benefits of SCTS compared to conventional ice cold storage (ICS) was evaluated. Between October 2015 and January 2022, 569 US adults receiving donor hearts preserved and transported either in SCTS (n = 255) or ICS (n = 314) were analyzed from the Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN-Heart) registry. Propensity matching and a subgroup analysis of >240 minutes ischemic time were performed to evaluate comparative outcomes. Overall, the SCTS cohort had significantly lower rates of severe primary graft dysfunction (PGD) ( p = 0.03). When propensity matched, SCTS had improving 1-year survival ( p = 0.10), significantly lower rates of severe PGD ( p = 0.011), and lower overall post-transplant MCS utilization ( p = 0.098). For patients with ischemic times >4 hours, the SCTS cohort had reduced post-transplant MCS utilization ( p = 0.01), reduced incidence of severe PGD ( p = 0.005), and improved 30-day survival ( p = 0.02). A multivariate analysis of independent risk factors revealed that compared to SCTS, use of ice results in a 3.4-fold greater chance of severe PGD ( p = 0.014). Utilization of SCTS is associated with a trend toward increased post-transplant survival and significantly lower severe PGD and MCS utilization. These findings fundamentally challenge the decades-long status quo of transporting donor hearts using ice.
Collapse
Affiliation(s)
- Yasuhiro Shudo
- From the Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Corewell Health (formerly Spectrum Health), Grand Rapids, Michigan
| | - Hannah Copeland
- Department of Cardiothoracic Surgery, Lutheran Health, Fort Wayne, Indiana
| | - Scott Silvestry
- Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida
| | - Si M. Pham
- Department of Cardiovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ezequiel Molina
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (current affiliation: Piedmont Heart Institute, Atlanta, Georgia)
| | - Jacob N. Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Jeffrey P. Jacobs
- Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, Congenital Heart Center, UF Health Shands Hospital, Gainesville, Florida
| | - Masashi Kawabori
- Cardiovascular Center, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Dan M. Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Andreas Zuckermann
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - David A. D’Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston Massachusetts
| |
Collapse
|
4
|
Zhu Y, Shudo Y, He H, Kim JY, Elde S, Williams KM, Walsh SK, Koyano TK, Guenthart B, Woo YJ. Outcomes of Heart Transplantation Using a Temperature-controlled Hypothermic Storage System. Transplantation 2023; 107:1151-1157. [PMID: 36510359 DOI: 10.1097/tp.0000000000004416] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The SherpaPak Cardiac Transport System is a novel technology that provides stable, optimal hypothermic control during organ transport. The objectives of this study were to describe our experience using the SherpaPak system and to compare outcomes after heart transplantation after using SherpaPak versus the conventional static cold storage method (non-SherpaPak). METHODS From 2018 to June 2021, 62 SherpaPak and 186 non-SherpaPak patients underwent primary heart transplantation at Stanford University with follow-up through May 2022. The primary end point was all-cause mortality, and secondary end points were postoperative complications. Optimal variable ratio matching, cox proportional hazards regression model, and Kaplan-Meier survival analyses were performed. RESULTS Before matching, the SherpaPak versus non-SherpaPak patients were older and received organs with significantly longer total allograft ischemic time. After matching, SherpaPak patients required fewer units of blood product for perioperative transfusion compared with non-SherpaPak patients but otherwise had similar postoperative outcomes such as hospital length of stay, primary graft dysfunction, inotrope score, mechanical circulatory support use, cerebral vascular accident, myocardial infarction, respiratory failure, new renal failure requiring dialysis, postoperative bleeding or tamponade requiring reoperation, infection, and survival. CONCLUSIONS In conclusion, this is one of the first retrospective comparison studies that evaluated the outcomes of heart transplantation using organs preserved and transported via the SherpaPak system. Given the excellent outcomes, despite prolonged total allograft ischemic time, it may be reasonable to adopt the SherpaPak system to accept organs from a remote location to further expand the donor pool.
Collapse
Affiliation(s)
- Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, CA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
The Future of Heart Procurement with Donation after Circulatory Death: Current Practice and Opportunities for Advancement. J Heart Lung Transplant 2022; 41:1385-1390. [DOI: 10.1016/j.healun.2022.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/16/2022] [Accepted: 06/20/2022] [Indexed: 12/12/2022] Open
|
6
|
Krishnan A, Wang H, MacArthur JW. Applications of Tissue Decellularization Techniques in Ventricular Myocardial Biofabrication. Front Bioeng Biotechnol 2022; 10:802283. [PMID: 35265593 PMCID: PMC8899393 DOI: 10.3389/fbioe.2022.802283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Ischemic heart disease is the leading cause of death around the world, and though the advent of coronary revascularization has revolutionized its treatment, many patients who sustain ischemic injury to the heart will go on to develop heart failure. Biofabrication of ventricular myocardium for replacement of irreversibly damaged ischemic myocardium is sought after as a potential therapy for ischemic heart failure, though challenges in reliably producing this biomaterial have limited its clinical application. One method that shows promise for generation of functional myocardium is the use of tissue decellularization to serve as a scaffold for biofabrication. This review outlines the methods, materials, challenges, and prospects of tissue decellularization techniques for ventricular myocardium biofabrication. Decellularization aims to preserve the architecture and composition of the extracellular matrix of the tissue it is applied to, allowing for the subsequent implantation of stem cells of the desired cell type. Decellularization can be achieved with multiple reagents, most of which have detergent properties. A variety of cell types can be implanted in the resulting scaffold, including cardiac progenitor cells, and embryonic or induced pluripotent stem cells to generate a range of tissue, from patches to beating myocardium. The future of this biofabrication method will likely emphasize patient specific tissue engineering to generate complex 3-dimensional constructs that can replace dysfunctional cardiac structures.
Collapse
Affiliation(s)
- Aravind Krishnan
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - John Ward MacArthur
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
7
|
Hullin R, Meyer P, Yerly P, Kirsch M. Cardiac Surgery in Advanced Heart Failure. J Clin Med 2022; 11:773. [PMID: 35160225 PMCID: PMC8836496 DOI: 10.3390/jcm11030773] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 02/05/2023] Open
Abstract
Mechanical circulatory support and heart transplantation are established surgical options for treatment of advanced heart failure. Since the prevalence of advanced heart failure is progressively increasing, there is a clear need to treat more patients with mechanical circulatory support and to increase the number of heart transplantations. This narrative review summarizes recent progress in surgical treatment options of advanced heart failure and proposes an algorithm for treatment of the advanced heart failure patient at >65 years of age.
Collapse
Affiliation(s)
- Roger Hullin
- Cardiology, Cardiovascular Department, University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland;
| | - Philippe Meyer
- Cardiology, Department of Medical Specialties, Geneva University Hospital, University of Geneva, Rue du Gabrielle Perret-Gentil 4, 1205 Geneva, Switzerland;
| | - Patrick Yerly
- Cardiology, Cardiovascular Department, University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland;
| | - Matthias Kirsch
- Cardiac Surgery, Cardiovascular Department, University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland;
| |
Collapse
|