Systems and methods for ex-vivo organ care and for using lactate as an indication of donor organ status
The disclosure provides, in various embodiments, systems, devices and methods relating to ex-vivo organ care. In certain embodiments, the disclosure relates to maintaining an organ ex-vivo at near-physiologic conditions. The present application describes, for example, a method for using lactate measurement in the arterial and the venous blood lines of the Organ Care System Heart perfusion device to evaluate, for example, the: 1) overall perfusion status of an isolated heart; 2) metabolic status of an isolated heart; and 3) overall vascular patency of an isolated donor heart. This aspect of the present disclosure may use, for example, the property of myocardial cell's unique ability to produce/generate lactate when they are starved for oxygen and metabolize/utilize lactate for energy production when they are well perfused with oxygen.
1. A method comprising:
receiving an ex vivo heart in a protective chamber of an organ care system;
pumping a perfusion fluid, via a perfusion circuit coupled to the ex vivo heart, into the ex vivo heart;
measuring an aortic pressure of the ex vivo heart;
obtaining a plurality of lactate differentials over time, wherein obtaining each lactate differential of the plurality of lactate differentials over time comprises:
measuring a first lactate value of the perfusion fluid in a first conduit, wherein the perfusion fluid in the first conduit is flowing into the ex vivo heart;
measuring a second lactate value of the perfusion fluid in a second conduit, wherein the perfusion fluid in the second conduit is flowing away from the ex vivo heart; and
subtracting the first lactate value of the perfusion fluid in the first conduit from the second lactate value of the perfusion fluid in the second conduit to obtain a lactate differential; and
correlating the plurality of lactate differentials over time and the aortic pressure with a transplantation suitability of the ex vivo heart, wherein at least two values of zero or less of the plurality of lactate differentials over time indicates that the ex vivo heart is suitable for transplantation.
2. The method of claim 1 , wherein obtaining the plurality of lactate differentials over time comprises obtaining, at regular time intervals, the plurality of lactate differentials over time.
3. The method of claim 1 , comprising:
obtaining a first lactate differential about 60 minutes or less before obtaining a second lactate differential.
4. The method of claim 1 , comprising:
obtaining the plurality of lactate differentials over more than one hour.
5. The method of claim 1 , comprising:
measuring a pressure of the perfusion fluid in the first conduit.
6. The method of claim 5 , comprising:
correlating the pressure of the perfusion fluid in the first conduit and the plurality of lactate differentials over time with a coronary vascular patency of the ex vivo heart.
7. The method of claim 1 , wherein the at least two values of zero or less of the plurality of lactate differentials over time indicates that there is an adequate perfusion of the ex vivo heart and that a plurality of myocardial cells is not producing lactate.
8. A method comprising:
receiving an ex vivo heart in a protective chamber of a portable organ care system;
flowing a perfusion fluid into a perfusion circuit connected to the ex vivo heart;
measuring an aortic pressure of the ex vivo heart;
measuring a first lactate value of the perfusion fluid in a first conduit of the perfusion circuit, wherein the perfusion fluid in the first conduit of the perfusion circuit is flowing into the ex vivo heart;
measuring a second lactate value of the perfusion fluid in a second conduit of the perfusion circuit, wherein the perfusion fluid in the second conduit of the perfusion circuit is flowing away from the ex vivo heart;
subtracting the first lactate value in the first conduit of the perfusion circuit from the second lactate value in the second conduit of the perfusion circuit to obtain a first lactate differential;
measuring a third lactate value of the perfusion fluid in the first conduit of the perfusion circuit;
measuring a fourth lactate value of the perfusion fluid in the second conduit of the perfusion circuit;
subtracting the third lactate value in the first conduit of the perfusion circuit from the fourth lactate value in the second conduit of the perfusion circuit to obtain a second lactate differential; and
correlating the first lactate differential, the second lactate differential, and the aortic pressure with a transplantation suitability of the ex vivo heart, wherein a value of zero or less of the first lactate differential and a value of zero or less of the second lactate differential indicate that the ex vivo heart is suitable for transplantation.
9. The method of claim 8 , comprising:
measuring a pressure of the perfusion fluid in the first conduit of the perfusion circuit.
10. The method of claim 9 , comprising:
correlating the pressure of the perfusion fluid in the first conduit of the perfusion circuit, the first lactate differential, and the second lactate differential with a coronary vascular patency of the ex vivo heart.
11. The method of claim 8 , wherein the value of zero or less of the first lactate differential and the value of zero or less of the second lactate differential indicate that there is an adequate perfusion of the ex vivo heart and that a plurality of myocardial cells is not producing lactate.
12. A method comprising:
receiving an ex vivo heart in a protective chamber of an organ care system;
pumping a perfusion fluid into the ex vivo heart via a retrograde perfusion through a first vessel of the ex vivo heart;
flowing the perfusion fluid away from the ex vivo heart via a second vessel of the ex vivo heart;
measuring an aortic pressure of the ex vivo heart;
measuring a first lactate value of the perfusion fluid in the first vessel of the ex vivo heart;
measuring a second lactate value of the perfusion fluid in the second vessel of the ex vivo heart;
subtracting the first lactate value from the second lactate value to obtain a first lactate differential;
measuring a third lactate value of the perfusion fluid in the first vessel of the ex vivo heart;
measuring a fourth lactate value of the perfusion fluid in the second vessel of the ex vivo heart;
subtracting the third lactate value from the fourth lactate value to obtain a second lactate differential; and
correlating the first lactate differential, the second lactate differential, and the aortic pressure with a transplantation suitability of the ex vivo heart, wherein a value of zero or less of the first lactate differential and a value of zero or less of the second lactate differential indicate that the ex vivo heart is suitable for transplantation.
13. The method of claim 12 , wherein the value of zero or less of the first lactate differential and the value of zero or less of the second lactate differential indicate that there is an adequate perfusion of the ex vivo heart and that a plurality of myocardial cells is not producing lactate.
14. The method of claim 12 , comprising:
increasing a flow rate of the perfusion fluid pumped into the ex vivo heart in response to a value of more than zero of the first lactate differential or a value of more than zero of the second lactate differential.
15. A method comprising:
receiving an ex vivo heart in a protective chamber of an organ care system;
pumping a perfusion fluid into the ex vivo heart via a first conduit;
flowing the perfusion fluid away from the ex vivo heart via a second conduit;
measuring an aortic pressure of the ex vivo heart;
measuring a first lactate value of the perfusion fluid in the first conduit;
measuring a second lactate value of the perfusion fluid in the second conduit;
subtracting the first lactate value from the second lactate value to obtain a first lactate differential;
measuring a third lactate value of the perfusion fluid in the first conduit;
measuring a fourth lactate value of the perfusion fluid in the second conduit;
subtracting the third lactate value from the fourth lactate value to obtain a second lactate differential; and
correlating the first lactate differential, the second lactate differential, and the aortic pressure with a transplantation suitability of the ex vivo heart, wherein a value of zero or less of the first lactate differential and a value of zero or less of the second lactate differential indicate that the ex vivo heart is suitable for transplantation.
16. The method of claim 15 , comprising:
measuring a pulmonary artery pressure of the ex vivo heart; and
correlating the pulmonary artery pressure, the first lactate differential, and the second lactate differential with the transplantation suitability of the ex vivo heart.
17. The method of claim 15 , wherein the value of zero or less of the first lactate differential and the value of zero or less of the second lactate differential indicate that there is an adequate perfusion of the ex vivo heart and that a plurality of myocardial cells is not producing lactate.
18. A method comprising:
receiving an ex vivo heart in a protective chamber of an organ care system;
measuring an aortic pressure of the ex vivo heart;
perfusing the ex vivo heart with a perfusion fluid, the perfusing comprising:
pumping the perfusion fluid into the ex vivo heart via a first conduit; and
flowing the perfusion fluid away from the ex vivo heart via a second conduit;
measuring a first lactate value of the perfusion fluid in the first conduit;
measuring a second lactate value of the perfusion fluid in the second conduit;
subtracting the second lactate value from the first lactate value to obtain a first lactate differential;
measuring a third lactate value of the perfusion fluid in the first conduit;
measuring a fourth lactate value of the perfusion fluid in the second conduit;
subtracting the fourth lactate value from the third lactate value to obtain a second lactate differential; and
correlating the first lactate differential, the second lactate differential, and the aortic pressure with a transplantation suitability of the ex vivo heart, wherein a value of zero or less of the first lactate differential and a value of zero or less of the second lactate differential indicate that the ex vivo heart is suitable for transplantation.
19. The method of claim 18 , comprising:
obtaining, at regular time intervals, a plurality of lactate differentials.
20. The method of claim 19 , comprising:
obtaining the first lactate differential about 60 minutes or less before obtaining the second lactate differential.
21. The method of claim 19 , comprising:
obtaining the plurality of lactate differentials over more than one hour.
22. The method of claim 18 , wherein the value of zero or less of the first lactate differential and the value of zero or less of the second lactate differential indicate that there is an adequate perfusion of the ex vivo heart and that a plurality of myocardial cells is not producing lactate.