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Ex-vivo-Herzperfusion zur Steigerung der Organverfügbarkeit

Ex vivo heart perfusion for increasing organ availability

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Hintergrund

Die Herztransplantation stellt nach wie vor den Goldstandard für Patienten mit terminaler Herzinsuffizienz dar. Durch den Mangel an Spenderorganen erlangt die Anwendung der Ex-vivo-Herzperfusion zunehmende Bedeutung in der Rekonditionierung marginaler Spenderorgane.

Ziel der Arbeit

Neue Entwicklungen auf dem Gebiet der Ex-vivo-Herzperfusion sollen aufgezeigt und die praktische Anwendung bei der Organentnahme dargestellt werden.

Material und Methoden

Hierzu wird die Anwendung des Organ Care System (OCS; Fa. TransMedics, Inc., Andover, MA, USA) zur Evaluierung und zur Konditionierung von marginalen Spenderorganen vor dem Hintergrund des eklatanten Organmangels diskutiert.

Ergebnisse

Die OCS-Präservation ist im Vergleich zur kalten Kardioplegie in der klinischen Anwendung als gleichwertig einzustufen. Das OCS Heart reduziert hochsignifikant die kalte Ischämiezeit, sodass längere Transportzeiten und konsekutiv ein größerer Entnahmeradius für Spenderherzen möglich sind. „Extended criteria donors“ können bei professioneller Anwendung mit dem OCS zu geeigneten Spenderorganen konditioniert werden. Die Reanimation von „Donation-after-cardiac-death“(DCD)-Herzen mithilfe des OCS wurde international klinisch etabliert und zeigt vielversprechende Ergebnisse.

Schlussfolgerung

Wir postulieren die standardisierte Anwendung der Ex-vivo-Herzperfusion für marginale Organe zur Erweiterung des potenziellen Spender-Pools.

Abstract

Background

Heart transplantation still remains the gold standard for patients with end-stage heart failure. Due to the lack of donor organs the use of ex vivo heart perfusion is becoming increasingly more important for reconditioning marginal donor organs.

Objective

New developments in the field of ex vivo heart perfusion are presented with an emphasis on the practical application in a donor organ retrieval service.

Material and methods

The utilization of the Organ Care System (OCS, TransMedics, Andover, MA) for evaluation and reconditioning of marginal donor organs is discussed in the light of the substantial shortage of donor organs.

Results

Preservation using the OCS can be considered as being equivalent to cold cardioplegia in the clinical application. An OCS heart shows a highly significant reduction in the cold ischemia time so that longer transport times and subsequently greater catchment areas are possible. Extended criteria donors can be conditioned to be suitable donor organs by the professional application of the OCS. Resuscitation of so-called donation after cardiac death (DCD) donor hearts using OCS has been clinically established internationally and the results are very promising.

Conclusion

We postulate the standardized application of ex vivo heart perfusion for marginal donor organs to extend the potential donor pool.

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Authors and Affiliations

  1. Klinik für Herzchirurgie, Herz- und Marfanzentrum – Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    A. Weymann & A. Ruhparwar

  2. Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Hill End Road, UB9 6JH, Harefield, Middlesex, Vereinigtes Königreich

    A. Weymann, A. Sabashnikov, M. Zeriouh, A. R. Simon & A.‑F. Popov

  3. Klinik für Herz- und Thoraxchirurgie, Herzzentrum – Universität Köln, Kerpener Str. 61, 50924, Köln, Deutschland

    A. Sabashnikov & M. Zeriouh

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  1. A. Weymann
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  2. A. Sabashnikov
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  4. A. Ruhparwar
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  6. A.‑F. Popov
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Correspondence to A. Weymann.

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Interessenkonflikt

A. Weymann, A. Sabashnikov, M. Zeriouh, A. Ruhparwar, A. R. Simon und A.-F. Popov geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Weymann, A., Sabashnikov, A., Zeriouh, M. et al. Ex-vivo-Herzperfusion zur Steigerung der Organverfügbarkeit. Z Herz- Thorax- Gefäßchir 30, 140–146 (2016). https://doi.org/10.1007/s00398-015-0051-4

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  • DOI: https://doi.org/10.1007/s00398-015-0051-4

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