A recent study reveals that the risk of early heart failure following heart transplantation is reduced when the donor heart is preserved using a device known as a heart-in-a-box, rather than the traditional method of ice storage in a cooler. This finding comes from research conducted at the University of Gothenburg.
Typically, donated hearts are stored in a cooler with ice at a temperature of four degrees, submerged in a potassium solution. This method puts pressure on the medical team, as the heart must be matched, transported, and implanted within four hours to minimize complications for the recipient.
However, studies indicate that transport times can extend up to nine hours when using hypothermic oxygenated machine perfusion (HOPE), or the “heart-in-a-box,” instead of relying on traditional cold storage. In this innovative system, the heart is maintained at eight degrees while being oxygenated through a pump, a network of tubes, a reservoir, and a fluid that circulates through it while awaiting transplantation.
The purpose of the study published in The Lancet was to evaluate the safety and health results for heart recipients within the first 30 days post-transplant, comparing the heart-in-a-box method with conventional cooler storage. This study is the first of its kind to be randomized and controlled.
Conducted in Eight European Countries
A total of 204 adult patients seeking heart transplants at fifteen clinics across eight European countries participated in the study. Participants were randomly split into two groups: one group received hearts preserved in a heart-in-a-box, while the other received hearts stored using the standard cold static method. All donor hearts came from brain-dead individuals.
The findings revealed that recipients of hearts preserved in a heart-in-a-box faced a significantly lower risk of heart failure after transplantation compared to those whose hearts underwent standard cold storage. Specifically, the occurrence of severe organ failure, known as primary graft dysfunction (PGD), was recorded at 11% for the heart-in-a-box group compared to 28% for the conventional storage group.
No other notable differences in clinical events were observed between the two groups during the follow-up period. Further analysis of health outcomes for participants in the year following their heart transplants will be shared by the researchers later on.
A driving force behind this study is Andreas Wallinder, MD, PhD, a cardiothoracic surgeon and currently the Medical Director for XVIVO AB, who, along with Stig Steen, Senior Professor at Lund University, was instrumental in developing the heart-in-a-box technology.
“The oxygenation process within the box plays a vital role. In standard cold storage and transport, the heart is deprived of oxygen and blood flow, but with the box, oxygenated, nutrient-rich fluid is continuously circulated. This keeps the heart functioning optimally, leading to fewer post-transplant complications,” he explains.
Prospects for More Transplants
Professor Göran Dellgren, a specialist in Transplantation Surgery at Sahlgrenska Academy, University of Gothenburg, and a cardiac surgeon at Sahlgrenska University Hospital, was responsible for overseeing about twenty participants in the study.
“These outcomes represent a significant advancement in the field of transplantation, with the potential to broaden the scope of heart transplants. If utilized effectively, the heart-in-a-box can help mitigate various complications that typically result in patient distress, adverse outcomes, and even premature death, not to mention the financial burden associated with these issues,” he remarks.
“Moreover, this technology could allow for the longer-distance transportation of organs, hence increasing the availability of transplantable hearts. It may also enable the use of less than ideal organs from older donors, ultimately boosting the number of heart transplants,” Göran Dellgren concludes.
