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Are ex-vivo machine perfusion systems a viable option for cardiac allograft transportation? A systematic review and meta-analysis : a thesis submitted to the faculty of the Milwaukee School of Engineering in partial fulfillment of the requirements for the degree of Master of Science in Perfusion / by Chelsea L. Becker.

by Becker, Chelsea, author., Gerrits, Dr. Ronald, thesis advisor , Fennigkoh, Dr. Larry , Shimek, Gary , Milwaukee School of Engineering

[Milwaukee School of Engineering], [2018]

Heart -- Transplantation.

Heart, Mechanical

Isolation perfusion (Physiology)

leaves : illustrations, some of which are in color ; 29 cm

Introduction -- Background -- Methods -- Results -- Conclusion -- References -- Appendix A: Characteristics of the literature evaluated in this investigation.

Heart disease is the leading cause of death both globally and in the United States and often progresses to heart failure, which has a bleak prognosis. Upon diagnosis of end-stage heart failure, the gold standard treatment becomes heart transplantation. In the United States, there is a severe shortage of available organs, such that many people on the transplant list die while waiting. Addressing this problem can occur either by increasing the number of donors, or by developing better preservation methods so that a greater percentage of hearts are viable after harvesting and transport. Transport has historically occurred via hypothermic storage solution, but more recently an ex-vivo machine perfusion system has been investigated, with a goal of better preserving hearts and limiting the chance of primary graft dysfunction and therefore morbidity and mortality in the immediate post-operative period.

The goal of this project was to complete a meta-analysis comparing the traditional practice of static, hypothermic storage to the method of ex-vivo machine perfusion, using patient survival as the main outcome. Because of the limited data, both animal and human studies were included in the analysis.

A total of six articles were included in the analysis, which showed a survival rate of 90.6% with ex-vivo machine perfusion and 91.2% with static, hypothermic storage. This preliminary review indicates that survival rates may not differ between ex-vivo machine perfusion and static, hypothermic storage. Future studies should be completed to show that ex-vivo machine perfusion decreases post-operative complications in comparison to cold storage, even if long-term survival is unaffected.

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