Direct Procurement and Perfusion Using Hypothermic Oxygenated Perfusion for DCD Cardiac Allografts in North America
Bibliographic record
Abstract
BACKGROUND: Donation after circulatory death (DCD) is a viable avenue for recovery of cardiac allografts for transplantation. Previous methods have utilized direct procurement and perfusion (DPP) using commercially available normothermic perfusion systems or in situ normothermic regional perfusion. A novel portable hypothermic oxygenated perfusion device (HOPE) (XVIVO Perfusion) has been developed and is in clinical trials for preservation of cardiac allografts. Here, we report the first North American experience using a HOPE preservation device for DPP recovery of DCD cardiac allografts and detail our experience and early patient outcomes. METHODS: DCD cardiac allografts were procured and preserved using the HOPE platform and transported to our medical center for transplantation into awaiting recipients. Patient clinical course and outcomes are reported. Permission for this report was granted by the study sponsor and by our institutional review board. RESULTS: Five end-stage heart failure patients underwent orthotopic heart transplantation at our institution using DCD allografts preserved with the HOPE platform. Average preservation time was 298 min with no observed cases of severe primary graft dysfunction. One patient died because of multiple extracardiac complications, but with preserved allograft function, and 1 patient required mechanical circulatory support for secondary graft dysfunction. All patients surviving to discharge were alive at last follow-up. CONCLUSIONS: This early, limited, single-institution experience of DPP preservation of DCD cardiac allografts using a HOPE platform demonstrates early success in transplanting adequately functioning allografts with acceptable patient outcomes. Further study and experience with HOPE for DCD allografts is needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".