Cardiac preservation with normothermic donor heart perfusion compared to standard cold storage in heart transplantation: a new standard of care to face

The shortage of cardiac donors has led to a drop in the number of heart transplants and to the adaptation of less restrictive selection criteria, thus increasing the risk of early mortality. Employing ex vivo preservation in a beating status of donor hearts with Organ Care System (OCS) it is possible to reduce the ischaemic time, to resuscitate suboptimal hearts, to recruit long distance donors, thus expanding the donor pool. Better cardiopreservation using ex vivo perfusion has been demonstrated in animal models, but this evidence lacks in humans. Our aim is to randomize 1:1, 30 heart transplants employing standard cold storage vs OCS perfusion and to compare the two procedures in terms of: clinical outcome, morphological and molecular evidences of myocardial injury and metabolic profile evaluated by Nuclear Magnetic Resonance. If OCS would offer a better myocardial preservation, this system should be evaluated as the gold standard fororgan preservation in larger, phase III studies.