(50) Recipient Outcomes with Extended Criteria Donors: An Analysis of the Guardian Heart Registry

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; pp. S31 - S32
• Main Authors: Moayedifar, R., Shudo, Y., Kawabori, M., Silvestry, S., Schroder, J., Meyer, D., D'Alessandro, D., Zuckermann, A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.066

The prevalence of end stage heart failure and patients that could benefit from heart transplantation requires expansion of the donor pool, relying on the transplant community to continually re-evaluate and expand the use of marginal donor organs. Introduction of new technologies such as the Paragonix SherpaPak Cardiac Transport System (CTS) aids in this shift. We seek to analyze the impact of the CTS system on recipient outcomes who receive extended criteria organs in the GUARDIAN Heart Registry. Between October 2015-August 2022, 761 adults from 9 US centers receiving donor hearts utilizing either CTS (N=419) or conventional ice storage (ICE, N=342) were analyzed from the GUARDIAN Heart registry using summary statistics. A modified EXPAND OCS Trial criteria was used to delineate cohorts of extended criteria donors, which included 176 CTS and 132 ICE (see Table). Forty percent of the total US donors in the registry population met the extended criteria definition. There were few baseline differences among recipients in the 2 cohorts, most notably both distance traveled and total ischemic time was significantly greater in CTS, and significantly more donor hearts in the CTS cohort had >4 hours total ischemia time, although baseline VAD was higher in the ICE cohort. Post-transplant MCS utilization and New ECMO/VAD was significantly reduced, and the rate of severe PGD was significantly reduced by over 50% in hearts preserved using CTS. Survival between cohorts was similar. This subgroup analysis demonstrates that SherpaPak CTS can be safely used to utilize extended criteria donors, with low severe PGD rates. This is encouraging toward use of extended criteria donors in European transplant programs, though further clinical evaluation in Europe is warranted.