Heart donation after circulatory death (DCD) is feasible although little is known about the hemodynamic and functional parameters of these marginal donor organs. We conducted a pre-clinical study utilizing human DCD hearts to assess the resuscitated LV function as well as the course of cardiac enzyme and cytokine production in the perfusate.

Methods: Six human donors underwent heart procurement after circulatory death and withdrawal of life support (WLS). After cold cardioplegia, normothermic ex vivo perfusion was initiated using the Organ Care System (Transmedics®). Lactate trends and hemodynamics were assessed in 4/6 hearts using a balloon placed in the left ventricle. LVEDP as well as systolic left ventricular pressure (sysLVP) were recorded as the volume of the balloon was gradually increased. Perfusate was analyzed for cytokine analysis and cardiac markers using Luminex bead based technique.

Results: Time between WLS and declaration of death varied between 15-44 minutes and time between declaration of death and cold cardioplegia ranged between 5-10 minutes. Total median warm ischemic time was 27 (IQR 25-38.5) minutes. Normothermic perfusion was performed for a median of 286(IQR 244-329.8) minutes. Favorable lactate trends were seen in two hearts whereas three donor hearts showed increasing lactate trends over time. Hearts that produced lactate demonstrated signs of myocardial edema and decreased contractility. Donor hearts that utilized lactate demonstrated favorable systolic and diastolic properties (sysLVP 103.4±7.9mmHg, mean LVEDP 11.0±0.8mmHg at 60 ml balloon filling), whereas donor hearts which produced lactate showed impaired systolic and diastolic dysfunction (sysLVP 90.9±23.9mmHg, LVEDP 14.55±8.7mmHg at 60 ml balloon filling).

After 4 hours of normothermic perfusion, Troponin-I (103.1±64.7 vs. 42.3±10.7 ng/l, p=0.40) showed higher concentrations in the perfusate of hearts with uptrending lactate levels as compared to hearts with downtrending lactate levels. Similar results were detectable in cytokine analysis including TNF-α (132.6 vs. 67.8 pg/ml, p=0.20), IL-1β (4.6±2.3 vs. 1.9±0.7 pg/ml, p=0.40) as well as IL-6 (3411.4±352.6 vs. 2097.1±997.2 pg/ml, p=0.20) .

Conclusion: Donor hearts can be adequately resuscitated from select donors following circulatory death. Lactate trends correlate with functional assessment and biochemical markers of myocyte injury.

CITATION INFORMATION: Sommer W., Roy N., Kilmarx S., O. J., Titus J., Villavicencio M., Stone J., Madsen J., D'Alessandro D. Hemodynamic and Functional Analysis of Human DCD Hearts Undergoing Normothermic Ex Vivo Perfusion Am J Transplant. 2017;17 (suppl 3).

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