Portable Heart Boxes Enables Safer Transplantation

A portable non-ischemic heart preservation (NIHP) device facilitates ground and airborne transportation of human hearts, according to a new study.

Researchers at Lund University (LU; Sweden) and Skåne University Hospital (Skåne; Malmö, Sweden) conducted a prospective, open-label, phase II study comparing NIHP to static cold preservation (SCS) in 31 adult recipients on waiting lists for heart transplantation; of these, six were assigned to NIHP and 25 to SCS. NIHP was scheduled in advance, based on availability of trained team members. The primary endpoint was a composite of survival free of severe primary graft dysfunction, extracorporeal membrane oxygenation (ECMO) use within seven days, and acute cellular rejection within six months.

The results showed median preservation time was 223 minutes for NIHP and 194 minutes for SCS. Over the first six months, all of the patients assigned to NIHP achieved event-free survival, compared to 18 of those assigned to SCS (72%); these included four deaths and three cardiac-related adverse events. In addition, creatine kinase myocardial band (CK-MB) level assessed six hours after ending perfusion was 76 ng/mL for NIHP, compared with 138 ng/mL for SCS. The study was published on June 12, 2020, in Nature Communications.

“Our study shows that the new method enables longer preservation than today. If we, in our continued research, can establish that this is possible, it would mean entirely new opportunities for transplants. It would, for example, be possible to fly hearts between countries, which we are currently cannot,” said lead author Professor Johan Nilsson, MD, of LU and Skåne. “Although it is too early to draw far-reaching conclusions, we are obviously hopeful. If our results continue to be positive, the method could make a big difference for patients needing a heart transplant.”

The cornerstone of organ preservation has been SCS, which is ischemic. Although SCS reduces the extent of organ damage during transport, significant deterioration of the donated organ still occurs; the longer the organ is kept on ice, the greater the damage. During NIHP, in contrast, the heart is continuously perfused with a cold (8 °C) oxygenated cardioplegic nutrition–hormone solution containing erythrocytes. It is estimated that 60-65% of donor hearts globally cannot ultimately be used for transplantation due to the limitations of cold storage.

Related Links:
Lund University
Skåne University Hospital