22.08.2024

A recent study from the University of Gothenburg, published in The Lancet, highlights a significant improvement in heart transplant outcomes when donor hearts are preserved using hypothermic oxygenated machine perfusion, commonly known as "heart-in-a-box," compared to the traditional method of cold static storage.

This study, conducted across eight European countries, shows that the heart-in-a-box method reduces the risk of early heart failure and severe complications in transplant recipients.

Image: Medical staff carry cool box on the aircraft.

The risk of early heart failure after heart transplantation is lower if the donor heart is stored in a so-called heart-in-a-box instead of in the usual cooler with ice.

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Heart preservation: Traditional method vs. "heart-in-a-box"

Traditionally, donor hearts are preserved in a cooler at four degrees Celsius in a potassium solution, allowing for a limited preservation window of up to four hours. This method requires that matching, transportation, and surgery occur in rapid succession to minimize the risk of complications for the recipient.

The "heart-in-a-box" system, on the other hand, maintains the heart at eight degrees Celsius and provides oxygenation through a pump and fluid circulation. This method allows for longer transportation times of up to nine hours, potentially expanding the range of donor organs and reducing the urgency of matching and transplantation.

Study findings: Reduced risk of complications

The study included 204 adult patients from 15 clinics across eight European countries. Half of the participants received hearts preserved in the heart-in-a-box, while the other half received hearts stored in the traditional cooler method. The results showed that recipients who received hearts stored in the heart-in-a-box experienced significantly fewer complications. The risk of severe organ failure, known as primary graft dysfunction (PGD), was 11 percent in the heart-in-a-box group compared to 28 percent in the group using traditional storage methods.

Dr. Andreas Wallinder, a cardiothoracic surgeon and Medical Director of XVIVO AB, emphasizes the importance of oxygenation during heart preservation. “The oxygenation of the heart that takes place in the box is crucial. During normal cold storage and transportation, we have no oxygenation or circulation in the cells, but when we use the box, oxygenated and nutrient-rich fluid is continuously pumped through the heart, which allows the heart to function better and results in fewer complications in the recipient after the transplant,” Wallinder explains.

Potential for more heart transplants

The heart-in-a-box method offers new possibilities for the field of transplantation. The study's initial findings are limited to the first 30 days after transplantation. Researchers plan to present further analysis on the health outcomes of the participants during the first year after their heart transplants.

The heart-in-a-box method represents a promising advancement in heart transplantation, improving patient outcomes and potentially increasing the availability of donor organs. The continuous oxygenation and circulation provided by the heart-in-a-box reduce the risk of severe complications and could pave the way for more successful transplants in the future.

MEDICA-tradefair.com; Source: The Swedish Research Council

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