Longest Storage Period with Static Hypothermic Preservation in Cardiac Transplantation: Initial Experience in the West Coast

Introduction Improvement in preservation and transportation conditions has the potential to enhance organ quality at the time of transplant, optimize patient outcomes, and prolong the acceptable maximum allograft ischemic time. Herein, we describe our initial successful experience with the static hypothermic preservation system (Paragonix) for a donor heart. Our storage period and allograft ischemic time are the longest reported in the literature. Case Report A 68-year-old woman with HF was listed for transplantation. A donor heart was procured from a hospital located 3.5 hours away. The donor allograft was secured and packaged using the SherpaPak™ device (Fig. 1); total storage period was 283 mins. Heart transplantation was performed in standard fashion. AV conduction and normal sinus rhythm were regained after 7 mins of reperfusion. Total ischemic time was 330 mins, including a warm ischemic time of 20 minutes. The recipient CPB time and aortic cross clamp time were 153 and 50 mins, respectively. The patient recovered well and was discharged on postoperative day 10. At three months post-transplant, the patient continues to have excellent graft function without any evidence of rejection. Summary Historically, Shumway et al. initially obtained donor hearts from operating rooms immediately adjacent to a recipient. Over time, donor distance and allograft ischemic times have increased with advances in cardiac preservation. However, long cold ischemic times may induce PGD, cardiac allograft vasculopathy, and contribute to increased length of stay. Maintaining storage temperatures within the narrow range of 4-8°C is optimal for the preservation of high energy phosphate stores and avoids the risk of cold ischemic injury at temperatures below 2°C. By expanding geographic boundaries and total ischemic times, we believe that regulated static hypothermic preservation is a useful addition to a growing armamentarium of devices and strategies to increase access to transplantation.