Hypothermic continuous machine perfusion improves metabolic preservation and functional recovery in heart grafts

The number of heart transplants is decreasing due to organ shortage, yet the donor pool could be enlarged by improving graft preservation. Hypothermic machine perfusion (MP) has been shown to improve kidney, liver, or lung graft preservation. Sixteen pig hearts were recovered following cardioplegia and randomized to two different groups of 4-hour preservation using either static cold storage (CS) or MP (Modified LifePort (c) System, Organ Recovery Systems (c), Itasca, Il). The grafts then underwent reperfusion on a Langendorff for 60 min. Energetic metabolism was quantified at baseline, postpreservation, and postreperfusion by measuring lactate and high-energy phosphates. The contractility index (CI) was assessed both in vivo prior to cardioplegia and during reperfusion. Following reperfusion, the hearts preserved using CS exhibited higher lactate levels (56.63 +/- 23.57 vs. 11.25 +/- 3.92 mu mol/g; P < 0.001), increased adenosine monophosphate/adenosine triphosphate (AMP/ATP) ratio (0.4 +/- 0.23 vs. 0.04 +/- 0.04; P < 0.001), and lower phosphocreatine/creatine (PCr/Cr) ratio (33.5 +/- 12.6 vs. 55.3 +/- 5.8; P < 0.001). Coronary flow was similar in both groups during reperfusion (107 +/- 9 vs. 125 + /-9 ml/100 g/min heart; P = ns). CI decreased in the CS group, yet being well-preserved in the MP group. Compared with CS, MP resulted in improved preservation of the energy state and more successful functional recovery of heart graft.