Page 61 - ANZCP Gazette May 2023

RETROSPECTIVE ANALYSIS OF LUNG TRANSPLANT PATIENTS
Viji Vincent AND Bojana Stepanovic
Fiona Stanley Hospital, WA
PURPOSE: Lung transplant surgeries are done either with/without Extra-corporeal circulatory (ECC) support, which are cardiopulmonary bypass (CPB) or veno-arterial extracorporeal membrane oxygenation (VA ECMO). This is a retrospective analysis of patients done at Fiona Stanley Hospital (FSH) in 2 years.
METHODOLOGY: The first lung transplant under VA ECMO at FSH was done on the 4th of October 2019. This retrospective analysis is a comparative study of outcomes of patients operated 1 year prior and after this date. Difference variables were compared like transfusion data, acute kidney injury (AKI), primary graft dysfunction, ventilation times, length of ICU and Hospital Stay, etc.
RESULTS: AKI, transfusion rates, length of ICU and hospital stay were higher in patients done under CPB comparatively. Patient outcomes done under ECMO were similar to patients done with no ECC support.
CONCLUSION: VA ECMO for lung transplant is safe to be used and better results can be expected compared to the use of CPB in most of the patients.
ORGAN PRESERVATION IN THE 2020S: XVIVO HEART BOX (PART 2)
Amber Darwinkel-Wodson, David Mcgiffin, David Kaye, John Fraser AND Christina Kure
The Alfred, Victoria
The XVIVO Heart Box (XHB) is an emerging technology in cardiac transplantation that protects the donor heart via Non-Ischaemic Heart Preservation (NIHP). A first- in-human trial utilising XHB demonstrated its safe use in human cardiac transplantation [1]. In response, an Australian and New Zealand multi-centre trial of extended (6-8 hours) NIHP of donor hearts for transplantation utilising XHB is underway.
PURPOSE: The current study is an open labelled, single arm, multi-centre clinical trial. It aims to investigate the effect of NIHP on donor hearts with extended ischaemic time (6-8 hours) with respect to immediate and long term post-transplant heart allograft function.
METHODOLOGY: The sample includes 10 donor hearts procured and transported with NIHP for < 6 hours of anticipated ischaemic time (phase 1), and 26 donor hearts with 6-8 hours anticipated ischaemic time (phase 2). Primary end-points are mortality, primary graft dysfunction and re-transplantation, collected immediately and at 30 days, 6 months and 12 months.
RESULTS: Preliminary research data as well as early experiences will be discussed, including challenges adapting to various institutions and overcoming portability logistics.
REFERENCES:
1. A nonrandomized open-label phase 2 trial of nonischemic heart preservation for human heart transplantation. Johan Nilsson, Victoria Jernryd, Guangqi Qin, Audrius Paskevicius, Carsten Metzsch, Trygve Sjöberg, Stig Steen. 1, June 12, 2020, Nature Communications, Vol. 11, p. 2976.
GASEOUS PERSUFFLATION TO PRESERVE DCD HEARTS - AN OVINE MODEL
Viji Vincent, Warren Pavey, Nicholas Grainger, Umar Ali, Anthea Raisis AND Rebecca Hahn
Fiona Stanley Hospital, WA
DCD (Donation after circulatory death) heart transplantation has become a clinical tool in the last 5 years. Outcomes are favourable in comparison to DBD (Donation after brain death) organs. However DCD transplantation remains a niche method employed in a few select centres due to the complexity of the procurement and storage techniques necessitated by the high metabolic demands of the heart.
Gaseous persufflation, first described by Magnus in 1902 may be a simpler, cheaper and more efficacious way of storing DCD or DBD hearts compared to current clinical techniques. While a small amount of work has been published on gas persufflation of hearts, a robust and replicable model describing procurement, persufflation and reanimation which allows administration of reperfusion injury modulators, akin to a clinical scenario is yet to be described.
We herein outline our ovine model of antegrade gas persufflation incorporating current clinical DCD definitions, nebuliser augmented persufflation allowing drug delivery, organ monitoring during persufflation and Langendorff like reanimation. We believe this model provides a platform for optimising persufflation to allow application in a clinical DCD setting.
INTERESTING PAEDIATRIC CASES: THE LAST 40 YEARS OF TETRALOGY OF FALLOT AND VSD SURGERIES AT RCH. HOW DO WE MEASURE PROGRESS?
Clarke Thuys
The Royal Children's Hospital, Victoria
PURPOSE: The aim of this audit was to track changes in patient and bypass parameters for patients undergoing repair of Tetralogy of Fallot or a ventricular septal defect from 1978 to 2021.
MAY 2023 | www.anzcp.org 58