Use of intraoperative haemoadsorption in patients undergoing heart transplantation: A proof-of-concept randomized trial

This randomized controlled trial investigates the clinical impact of intraoperative CytoSorb^® haemoadsorption in orthotopic heart transplantation (OHT) patients. The study involved 60 OHT recipients, randomly assigned into two groups: 30 patients receiving CytoSorb^® treatment and 30 patients receiving standard care. However, after exclusions, the CytoSorb^® group consisted of 30 patients and the control group had 25.

The primary aim was to compare the effectiveness of CytoSorb^® against standard care in various clinical parameters such as vasoactive-inotropic score (VIS), incidence of vasoplegic syndrome (VS), changes in procalcitonin (PCT) and C-reactive protein (CRP) levels, and intraoperative mycophenolic acid (MPA) concentration. Other outcomes included the frequency of post-operative organ dysfunction, major complications, adverse immunological events, length of in-hospital stay, and 1-year survival rates.

The findings revealed that patients in the CytoSorb^® group had significantly better outcomes. These included lower median VIS, reduced risk of early VS by 6.4 times, decreased PCT levels, shorter durations of mechanical ventilation and ICU stays, and lower rates of acute kidney injury (AKI) and renal replacement therapy (RRT). Additionally, more stable hepatic bilirubin excretion was observed, with no relevant adsorption effect on MPA. Importantly, there was no increase in early cardiac allograft rejection, 30-day mortality, or differences in 1-year survival rates between the groups.

Overall, the study concludes that intraoperative use of CytoSorb^® in heart transplant surgery can improve hemodynamic stability, mitigate the inflammatory response, reduce the duration of postoperative support, and lower rates of post-operative AKI and RRT without affecting immunosuppressant levels, increasing rejection rates, or adversely impacting survival rates. These findings suggest a beneficial role for CytoSorb^® in the management of patients undergoing OHT.

Read the study: https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.14632