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Despite improvements in circulatory support options, heart transplantation remains the gold-standard treatment for appropriate patients with advanced heart failure. Expansion of the heart pool has occurred with the use of donation after circulatory death and extended marginal criteria such as prolonged ischemic time. Longer ischemic time is associated with adverse impact on allograft function and on early renal function. Recent studies suggest that HMP may favorably influence early graft function despite prolonged ischemic time but renal outcomes are not known. The purpose of this study was to compare early renal outcomes in HMP vs conventional heart transplant (C-HTx) recipients. Renal function and need for dialysis were compared at 24, 48 and 72 hours in participants (n=32) of the Australia and New Zealand Trial of HMP (XVIVO, Sweden) compared to a cohort of conventional single center HTx patients (n=62). Despite the prolonged ischemic time (377±15 vs 185±15 mins, p<0.001) in HMP patients the use of renal replacement therapy (RRT) at 72 hours tended to be less than C-HTx (22% vs 37%). The post-operative increase in creatinine in non-RRT was attenuated in HMP vs C-HTx patients at 24 hrs (26±10 vs 49±7 umol/L, p=0.06), 48 hrs (23±12 vs 69±12 umol/L, p=0.008) and 72 hrs (14±13 vs 60±13 umol/L, p=0.03). Despite the use of donor hearts with prolonged ischemic times, renal outcomes in recipients of cardiac allografts preserved using HMP were comparable or better than those in patients with shorter ischemic times. [ABSTRACT FROM AUTHOR]

Despite improvements in circulatory support options, heart transplantation remains the gold-standard treatment for appropriate patients with advanced heart failure. The availability of donor hearts is significantly less than that required. Strategies to increase donor supply include donation after circulatory death and retrieval from remote locations. The safety and reliability of remote heart retrieval is impacted upon by the deleterious effects of long-ischemic times and early donor heart function is a key determinant of post-transplant outcomes. Recent experimental studies using HMP have demonstrated beneficial effects on donor heart function with ischemic times of up to 8 hours. The purpose of this clinical study is to investigate the effect of HMP on donor heart function following an ischemic time of 6-8 hours. Patients (n=36 including up to 2 run-in cases per site) undergoing heart transplantation at 5 centres in Australia and New Zealand will be recruited into this open label study. The primary study cohort will include patients receiving donor hearts that were projected to have an ischemic time of 6-8 hours transported to the recipient hospital using HMP (XVIVO, Sweden). Echocardiographic assessment of left and right ventricular performance will be assessed by the core-laboratory and correlated with clinical outcomes including inotropic requirement and intensive care.Taken together, this study seeks to demonstrate the ability of HMP to preserve early donor heart function in the setting of long ischemic times and to investigate the translation into early clinical outcomes. [ABSTRACT FROM AUTHOR]