‘Heart-in-a-Box’ Storage Superior to Standard Cooler for Heart Transplants

The risk of early heart failure following heart transplantation is lower if the donor heart is stored in a so-called “heart-in-a-box” instead of in the usual cooler with ice, according to a study conducted by the University of Gothenburg and published in The Lancet.

Typically, donated hearts are kept at 4 degrees in potassium solution in a cooler with ice. Handling these donated hearts is a race against time, where matching, transportation, and surgery need to happen within 4 hours to avoid increasing the risk of complications for the recipient.

Despite the conventional means of storage, recent studies have shown that transport times of up to 9 hours are no longer an obstacle if hypothermic oxygenated machine perfusion (HOPE) or a “heart-in-a-box” is used instead of static cold storage. Using box storage, the heart is kept at 8 degrees and oxygenated using a pump, a set of tubes, a reservoir, and a fluid that is circulated through the resting heart while waiting for the transplantation, according to researchers.

In the first randomized, controlled study of its kind, researchers analyzed 204 adult patients across 8 European registries for heart transplantation at 15 different clinics. As part of the analysis, half of the participants were randomly assigned to receive hearts handled in a “heart-in-a-box” and half received hearts from traditional cold static storage. All hearts came from brain-dead donors.

According to the results, heart recipients were significantly less likely to experience heart failure if the heart had been stored in a “heart-in-a-box” before transplantation, compared with standard cold static storage. Overall, the study found that the risk of severe organ failure and primary graft dysfunction was 11% in the heart-in-a-box group and 28% in those whose hearts were placed in a cooler.

“The results represent a breakthrough in transplantation, which could expand the field. Used correctly, the heart-in-a-box can reduce a number of complications that otherwise often result in suffering, poor outcomes, in the worst cases premature death, and also high costs,” said Göran Dellgren, a professor of transplantation surgery at Sahlgrenska Academy at the University of Gothenburg.

Prof. Dellgren added that, “in terms of time, organs can also be shipped longer distances, thus making more organs available for transplantation. It is also likely that we can start using less ideal organs from older donors, which could increase the number of heart transplants.”