Heart in the Box with Long Term Outcome Post-Heart Transplantation

Purpose The organ care system (OCS) has been found to have comparable 30-day mortality compared to standard of care (SOC) therapy for the donor heart. At our institution, we had previously shown comparable results on 1-year outcome in terms of rejection, antibody development and survival. In this current study, this cohort of patients were followed, and we evaluated long term results. Methods Between 2011 and 2013, we randomized 38 heart transplant (HTx) patients to either OCS or SOC. We assessed total ischemic time (TIT), cold ischemic time (CIT), development of de novo antibodies (abs) and donor specific antibodies (DSA) within 8 year post-HTx, 8-year survival, 8-year freedom from cardiac allograft vasculopathy (CAV), 8-year freedom from non-fatal major cardiac events (NF-MACE: Myocardial Infarction, Heart Failure, angioplasty, pacemaker/ICD, stroke), 8-year freedom from any-treated rejection (ATR), biopsy (bx) proven cellular rejection (ACR >2R), bx proven antibody-mediated rejection (AMR1, 2, or 3). Results OSC group had significant longer TIT but significantly shorter CIT compared to SOC. There was no statistically significant difference in 8-year freedom from CAV, NF-MACE, ATR, ACR and AMR. Moreover, 8-year survival was not statistically significant different between the two groups. There were total of 8 deaths in the OCS group and the cause of death included 3 immediate postoperative cases of hemorrhage and thrombotic event, two died of complications of malignancy, one due to multi-organ failure, one patient died due to complications of CMV infection and last patient died of unknown etiology. In the SOC group, there were 5 deaths. Causes of death included once case of rejection, one case of stroke, one patient died of CMV infection, one due to patient non-compliance, and one patient died of unknown cause at an outside hospital. Conclusion OCS appears to be a valid tool to extend total donor ischemic time without compromising long term outcomes.