Favorable Impact of Hypothermic Machine Perfusion (HMP) on Early Renal Outcomes in Patients Undergoing Heart Transplantation Using Prolonged (6-8 Hour) Donor Hearts.

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]