Comparison of Continuous Hypothermic Oxygenated Crystalloid Perfusion with the Novel Solution "Custodiol N " and Warm Blood Perfusion in a Porcine DCD Donation Model.

PURPOSE: Transplantation programs are worldwide burdened by the limited availability of suitable donor hearts, despite extending the donation criteria. Organ donation after circulatory death (DCD) became a reliable alternative over the past few years. Nevertheless, the grafts fetched as DCDs are submitted to a further ischemic insult due to the progressive hypoxia and circulatory arrest occurring between withdrawal of care and declaration of death. Although diverse storage and perfusion strategies exist to preserve DCD hearts, no direct comparison has yet been performed. The aim of the present study is to examine the effects of a novel cold crystalloid preservation solution (Custodiol-N) and warm blood perfusion protocols compared to simple cold storage in a porcine model.

METHODS: In 39 pigs, DCD was induced by asphyxia and the hearts underwent 30 min initial warm ischemia in the donor. The hearts were than explanted and divided in 4 groups: 1) control group (n=8) was placed directly in a Langendorff model. In group 2 (CSG, n=8) the hearts were flushed with 2L of 4°C Custodiol N solution and then stored in the same solution for 4h before evaluation. In group 3 (CCP, n=8), the hearts underwent a 4h continuous oxygenated 4°C cold machine perfusion cycle with Custodiol N. In group 4 (WBP, n=7) the hearts were placed on warm blood reperfusion for 4h. Left ventricular function was defined by dP/dt min & max at different ventricle filling volumes. Coronary blood flow (CBF) was measured at 100 mmHg perfusion pressure and Troponin T was collected up to 2 hours.

RESULTS: Both dP/dt min & max were significantly higher in the CPP group compared to the WBP group [-1038±182 vs -344±38 mmHg/s; p=0.0356 and 1441±194 vs 498±53 mmHg/s; p=0.0123 respectively]. CBF was also significantly higher in the CCP group [1145±57vs 726±72ml/min; p=0.0032]. Moreover, Troponin T was significantly elevated in the WBP compared to the CCP group [27477±11777 vs 251034±90247 pg/ml, p=0.0239]. There were no significant differences among the WBP, CSG and control groups.

CONCLUSION: Continuous hypothermic oxygenated crystalloid perfusion with the novel preservation solution Custodiol N offers superior preservation and resuscitation of DCD hearts in terms of functional recovery and myocardial enzyme release.