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Kothari P. Ex-Vivo Preservation of Heart Allografts—An Overview of the Current State. J Cardiovasc Dev Dis 2023; 10:jcdd10030105. [PMID: 36975869 PMCID: PMC10054234 DOI: 10.3390/jcdd10030105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
As heart transplantation continues to be the gold-standard therapy for end-stage heart failure, the supply-demand imbalance of available organs worsens. Until recently, there have been no advances in increasing the donor pool, as prolonged cold ischemic time excludes the use of certain donors. The TransMedics Organ Care System (OCS) allows for ex-vivo normothermic perfusion, which allows for a reduction of cold ischemic time and allows for long-distance procurements. Furthermore, the OCS allows for real-time monitoring and assessment of allograft quality, which can be crucial for extended-criteria donors or donation after cardiac death (DCD) donors. Conversely, the XVIVO device allows for hypothermic perfusion to preserve allografts. Despite their limitations, these devices have the potential to alleviate the supply-demand imbalance in donor availability.
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Affiliation(s)
- Perin Kothari
- School of Medicine, Stanford University, Stanford, CA 94305, USA
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52
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Moeslund N, Ertugrul IA, Hu MA, Dalsgaard FF, Ilkjaer LB, Ryhammer P, Pedersen M, Erasmus ME, Eiskjaer H. Ex-situ oxygenated hypothermic machine perfusion in donation after circulatory death heart transplantation following either direct procurement or in-situ normothermic regional perfusion. J Heart Lung Transplant 2023; 42:730-740. [PMID: 36918339 DOI: 10.1016/j.healun.2023.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Heart transplantation in donation after circulatory death (DCD) relies on warm perfusion using either in situ normothermic regional perfusion (NRP) or ex situ normothermic machine perfusion. In this study, we explore an alternative: oxygenated hypothermic machine perfusion (HMP) using a novel clinically applicable perfusion system, which is compared to NRP with static cold storage (SCS). METHODS In a porcine model, a DCD setting was simulated, followed by either (1) NRP and SCS (2) NRP and HMP with the XVIVO Heart preservation system or (3) direct procurement (DPP) and HMP. After preservation, heart transplantation (HTX) was performed. After weaning from cardiopulmonary bypass (CPB), biventricular function was assessed by admittance and Swan-Ganz catheters. RESULTS Only transplanted hearts in the HMP groups showed significantly increased biventricular contractility (end-systole elastance) 2 hour post-CPB (left ventricle absolute change: NRP HMP: +1.8 ± 0.56, p = 0.047, DPP HMP: +1.5 ± 0.43, p = 0.045 and NRP SCS: +0.97 ± 0.47 mmHg/ml, p = 0.21; right ventricle absolute change: NRP HMP: +0.50 ± 0.12, p = 0.025, DPP HMP: +0.82 ± 0.23, p = 0.039 and NRP SCS: +0.28 ± 0.26, p = 0.52) while receiving significantly less dobutamine to maintain a cardiac output >4l/min compared to SCS. Diastolic function was preserved in all groups. Post-HTX, both HMP groups showed significantly less increments in plasma troponin T compared to SCS. CONCLUSION In DCD HTX, increased biventricular contractility post-HTX was only observed in hearts preserved with HMP. In addition, the need for inotropic support and signs of myocardial damage were lower in the HMP groups. DCD HTX can be successfully performed using DPP followed by preservation with HMP in a preclinical setting.
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Affiliation(s)
- Niels Moeslund
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department for Clinical Medicine-Comparative Medicine Lab, Aarhus University, Aarhus, Denmark; Department for Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - Imran A Ertugrul
- Department for Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel A Hu
- Department for Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Frederik Flyvholm Dalsgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department for Clinical Medicine-Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Lars Bo Ilkjaer
- Department for Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Ryhammer
- Department for Anesthesiology, Region Hospital Silkeborg, Silkeborg, Denmark
| | - Michael Pedersen
- Department for Clinical Medicine-Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Michiel E Erasmus
- Department for Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Hans Eiskjaer
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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53
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Current status of adult cardiac surgery-part 2. Curr Probl Surg 2023; 60:101245. [PMID: 36642488 DOI: 10.1016/j.cpsurg.2022.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/13/2022] [Indexed: 12/13/2022]
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54
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Buratto E, Konstantinov IE. Commentary: Combined heart-lung procurement: Avoiding the bottleneck effect. J Thorac Cardiovasc Surg 2023; 165:197-198. [PMID: 33745709 DOI: 10.1016/j.jtcvs.2021.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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55
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Kittleson MM, Wittlieb-Weber C, Rossano JW. When art and science collide: The 2022 guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2022; 42:541-543. [PMID: 36564336 DOI: 10.1016/j.healun.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carol Wittlieb-Weber
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph W Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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Burrage MK, Cheshire C, Hey CY, Azam S, Watson WD, Bhagra S, Berman M, D'Errico L, Jenkins DP, Kaul P, Large S, Lewis C, Martinez L, Messer S, Page A, Parameshwar J, Pettit S, Rafiq M, Tsui S, Tweed K, Weir-McCall JR, Kydd A. Comparing Cardiac Mechanics and Myocardial Fibrosis in DBD and DCD Heart Transplant Recipients. J Card Fail 2022; 29:834-840. [PMID: 36521726 DOI: 10.1016/j.cardfail.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart transplantation (HTx) after donation after circulatory death (DCD) is an expanding practice but is associated with increased warm ischemic time. The impact of DCD HTx on cardiac mechanics and myocardial fibrosis has not been reported. We aimed to compare cardiac mechanics and myocardial fibrosis using cardiovascular magnetic resonance (CMR) imaging in donation after brain death (DBD) and DCD HTx recipients and healthy controls. METHODS AND RESULTS Consecutive HTx recipients between March 2015 and March 2021 who underwent routine surveillance CMR imaging were included. Cardiac mechanics were assessed using CMR feature tracking to compute global longitudinal strain, global circumferential strain, and right ventricular free-wall longitudinal myocardial strain. Fibrosis was assessed using late gadolinium enhancement imaging and estimation of extracellular volume. There were 82 (DBD n = 42, DCD n = 40) HTx recipients (aged 53 years, interquartile range 41-59 years, 24% female) who underwent CMR imaging at median of 9 months (interquartile range 6-14 months) after transplantation. HTx recipients had increased extracellular volume (29.7 ± 3.6%) compared with normal ranges (25.9%, interquartile range 25.4-26.5). Myocardial strain was impaired after transplantation compared with controls (global longitudinal strain -12.6 ± 3.1% vs -17.2 ± 1.8%, P < .0001; global circumferential strain -16.9 ± 3.1% vs -19.2 ± 2.0%, P = .002; right ventricular free-wall longitudinal strain -15.7 ± 4.5% vs -21.6 ± 4.7%, P < .0001). There were no differences in fibrosis burden (extracellular volume 30.6 ± 4.4% vs 29.2 ± 3.2%; P = .39) or cardiac mechanics (global longitudinal strain -13.1 ± 3.0% vs -12.1 ± 3.1%, P = .14; global circumferential strain -17.3 ± 2.9% vs -16.6 ± 3.1%, P = .27; right ventricular free-wall longitudinal strain -15.9 ± 4.9% vs -15.5 ± 4.1%, P = .71) between DCD and DBD HTx. CONCLUSIONS HTx recipients have impaired cardiac mechanics compared with controls, with increased myocardial fibrosis. There were no differences in early CMR imaging characteristics between DBD and DCD heart transplants, providing further evidence that DCD and DBD HTx outcomes are comparable.
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Affiliation(s)
- Matthew K Burrage
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | | | - Cong Ying Hey
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Saima Azam
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Sai Bhagra
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Marius Berman
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | | | - Pradeep Kaul
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Stephen Large
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Clive Lewis
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Luis Martinez
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Aravinda Page
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | | | | | - Steven Tsui
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Jonathan R Weir-McCall
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anna Kydd
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK.
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James L, LaSala VR, Hill F, Ngai JY, Reyentovich A, Hussain ST, Gidea C, Piper GL, Galloway AC, Smith DE, Moazami N. Donation after circulatory death heart transplantation using normothermic regional perfusion:The NYU Protocol. JTCVS Tech 2022; 17:111-120. [PMID: 36820336 PMCID: PMC9938390 DOI: 10.1016/j.xjtc.2022.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022] Open
Abstract
Objective This study aimed to evaluate the impact of cardiopulmonary bypass for thoraco-abdominal normothermic regional perfusion on the metabolic milieu of donation after cardiac death organ donors before transplantation. Methods Local donation after cardiac death donor offers are assessed for suitability and willingness to participate. Withdrawal of life-sustaining therapy is performed in the operating room. After declaration of circulatory death and a 5-minute observation period, the cardiac team performs a median sternotomy, ligation of the aortic arch vessels, and initiation of thoraco-abdominal normothermic regional perfusion via central cardiopulmonary bypass at 37 °C. Three sodium chloride zero balance ultrafiltration bags containing 50 mEq sodium bicarbonate and 0.5 g calcium carbonate are infused. Arterial blood gas measurements are obtained every 15 minutes after every zero balance ultrafiltration bag is infused, and blood is transfused as needed to maintain hemoglobin greater than 8 mg/dL. Cardiopulmonary bypass is weaned with concurrent hemodynamic and transesophageal echocardiogram evaluation of the donor heart. The remainder of the procurement, including the abdominal organs, proceeds in a similar controlled fashion as is performed for a standard donation after brain death donor. Results Between January 2020 and May 2022, 18 donation after cardiac death transplants using the thoraco-abdominal normothermic regional perfusion protocol were performed at our institution. The median donor age was 42.5 years (range, 20-51 years), and 88.9% (16/18) were male. The mean total donor cardiopulmonary bypass time was 88.8 ± 51.8 minutes. At the beginning of cardiopulmonary bypass, the average donor lactate was 9.4 ± 1.5 mmol/L compared with an average final lactate of 5.3 ± 2.7 mmol/L (P<.0001). The average beginning potassium was 6.5 ± 1.8 mmol/L compared with an average end potassium of 4.2 ± 0.4 mmol/L (P<.0001) . The average beginning hemoglobin was 6.8 ± 0.7 g/dL, and the average end hemoglobin was 8.2 ± 1.3 g/dL (P<.001) . On average, donation after cardiac death donors received transfusions of 2.3 ± 1.5 units of packed red blood cells. Of the 18 donors who underwent normothermic regional perfusion, all hearts were deemed suitable for recovery and successfully transplanted, a yield of 100%. Other organs successfully recovered and transplanted include kidneys (80.6% yield), livers (66.7% yield), and bilateral lungs (27.8% yield). Conclusions The use of cardiopulmonary bypass for thoraco-abdominal normothermic regional perfusion is a burgeoning option for improving the quality of organs from donation after cardiac death donors. Meticulous intraoperative management of donation after cardiac death donors with a specific focus on improving their metabolic milieu may lead to improved graft function in transplant recipients.
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Key Words
- CIT, cold ischemic time
- CPB, cardiopulmonary bypass
- DBD, donation after brain death
- DCD, donation after circulatory death
- DWIT, donor warm ischemic time
- ICU, intensive care unit
- NRP, normothermic regional perfusion
- OPO, Organ Procurement Organization
- TEE, transesophageal echocardiography
- UF, ultrafiltration
- WLST, withdrawal of life-sustaining therapy
- Z-BUF, zero-balance ultrafiltration
- donation after circulatory death
- heart transplantation
- normothermic regional perfusion
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Affiliation(s)
- Les James
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - V. Reed LaSala
- Department of General Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Fredrick Hill
- Perfusion Services, NYU Langone Health, New York, NY
| | - Jennie Y. Ngai
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, New York, NY
| | - Alex Reyentovich
- Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY
| | - Syed T. Hussain
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Claudia Gidea
- Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY
| | | | | | - Deane E. Smith
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Nader Moazami
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY,Address for reprints: Nader Moazami, MD, Division of Heart and Lung Transplantation and Mechanical Circulatory Support, Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, 530 1st Ave, Suite 9V, New York, NY 10016.
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58
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Gil-Jaurena JM, Pérez-Caballero R, Murgoitio U, Pardo C, Pita A, Calle C, Camino M, Medrano C. A Neonatal ABO non-compatible heart transplant from a circulatory-determined death donor using NRP/Cold storage. Pediatr Transplant 2022; 26:e14169. [PMID: 34661339 DOI: 10.1111/petr.14169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/16/2021] [Accepted: 10/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Donation after Circulatory death is gaining worldwide acceptance. Most protocols regard their first cases to be performed with donor and recipient in the same institution. Few records of children or distant procurement have been published. METHODS Our institution was offered a heart from a 3-day-old, 3.4-kg child, blood group A, suffering irreversible encephalopathy. Parents accepted withdrawal of life-sustaining therapy and agreed to donation. The donor hospital was located 340 km away. Concomitantly, a 2-month-old, 3.1 kg, blood group type B and with non-compaction ventricles was awaiting for the heart transplant in our unit. RESULTS Thirty-seven minutes after withdrawal of life-sustaining therapy, the heart arrested. Five minutes afterwards, a sternotomy was performed. The supra-aortic vessels were clamped altogether. Aorta and right appendage were cannulated and connected to heart-lung machine. The innominate artery above the clamp was severed. The heart resumed spontaneous rhythm in less than 1 min. Ventilation was restored and extracorporeal circulation was maintained for 32 min. Upon cardiologic arrest, the graft was harvested as routinely. The heart was cold-stored and transported by plane to our Hospital. An orthotopic bicaval transplant was performed. Overall cold ischaemia was 245 min. Ten weeks later, the child was discharged home in good condition. CONCLUSION Donation in circulatory death could increase the pool in neonates. Extracorporeal circulation proves successful for procurement in neonates. Distant procurement plus cold storage for donation in circulatory death is feasible. Donation in circulatory death and ABO non-compatible strategies are complementary to each other.
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Affiliation(s)
- Juan-Miguel Gil-Jaurena
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ramón Pérez-Caballero
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Uxue Murgoitio
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carlos Pardo
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Pita
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Corazón Calle
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Manuela Camino
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Pediatric Cardiology, Hospital Gregorio Marañón, Madrid, Spain
| | - Constancio Medrano
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Pediatric Cardiology, Hospital Gregorio Marañón, Madrid, Spain
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Qi X, Hatami S, Bozso S, Buchko M, Forgie KA, Olafson C, Khan M, Himmat S, Wang X, Nobes DS, Acker JP, Nagendran J, Freed DH. The evaluation of constant coronary artery flow versus constant coronary perfusion pressure during normothermic ex situ heart perfusion. J Heart Lung Transplant 2022; 41:1738-1750. [PMID: 36137869 DOI: 10.1016/j.healun.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Evidence suggests that hearts that are perfused under ex-situ conditions lose normal coronary vasomotor tone and experience contractile failure over a few hours. We aimed to evaluate the effect of different coronary perfusion strategies during ex situ heart perfusion on cardiac function and coronary vascular tone. METHODS Porcine hearts (n = 6 each group) were perfused in working mode for 6 hours with either constant aortic diastolic pressure (40 mmHg) or constant coronary flow rate (500 mL/min). Functional and metabolic parameters, cytokine profiles, cardiac and vascular injury, coronary artery function and oxidative stress were compared between groups. RESULTS Constant coronary flow perfusion demonstrated better functional preservation and less edema formation (Cardiac index: flow control = 8.33 vs pressure control = 6.46 mL·min-1·g-1, p = 0.016; edema formation: 7.92% vs 19.80%, p < 0.0001). Pro-inflammatory cytokines, platelet activation as well as endothelial activation were lower in the flow control group. Similarly, less cardiac and endothelial injury was observed in the constant coronary flow group. Evaluation of coronary artery function showed there was loss of coronary autoregulation in both groups. Oxidative stress was induced in the coronary arteries and was relatively lower in the flow control group. CONCLUSIONS A strategy of controlled coronary flow during ex situ heart perfusion provides superior functional preservation and less edema formation, together with less myocardial damage, leukocyte, platelet, endothelial activation, and oxidative stress. There was loss of coronary autoregulation and decrease of coronary vascular resistance during ESHP irrespective of coronary flow control strategy. Inflammation and oxidative stress state in the coronary vasculature may play a role.
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Affiliation(s)
- Xiao Qi
- Departments of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Sanaz Hatami
- Departments of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Sabin Bozso
- Departments of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Max Buchko
- Departments of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Keir A Forgie
- Departments of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Carly Olafson
- Centre for Innovation, Canadian Blood Services, Edmonton, AB, Canada
| | - Mubashir Khan
- Departments of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Sayed Himmat
- Departments of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Xiuhua Wang
- Departments of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David S Nobes
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, AB, Canada
| | - Jason P Acker
- Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; Centre for Innovation, Canadian Blood Services, Edmonton, AB, Canada
| | - Jayan Nagendran
- Departments of Surgery, University of Alberta, Edmonton, AB, Canada; Alberta Transplant Institute Edmonton, AB, Canada; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Darren H Freed
- Departments of Surgery, University of Alberta, Edmonton, AB, Canada; Physiology, University of Alberta, Edmonton, AB, Canada; Biomedical Engineering, University of Alberta, Edmonton, AB, Canada; Alberta Transplant Institute Edmonton, AB, Canada; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.
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Kwon JH, Ghannam AD, Shorbaji K, Welch B, Hashmi ZA, Tedford RJ, Kilic A. Early Outcomes of Heart Transplantation Using Donation After Circulatory Death Donors in the United States. Circ Heart Fail 2022; 15:e009844. [PMID: 36214116 DOI: 10.1161/circheartfailure.122.009844] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Limited donor availability and evolution in procurement techniques have renewed interest in heart transplantation (HT) with donation after circulatory death (DCD). The aim of this study is to evaluate outcomes of HT using DCD in the United States. METHODS The United Network for Organ Sharing registry was used to identify adult HT recipients from 2019 to 2021. Recipients were stratified between DCD and donation after brain death. Propensity-score matching was performed. Cox proportional hazards was used to identify independent predictors of 1-year mortality. Kaplan-Meier analysis was used to estimate 1-year survival. RESULTS Of 7496 HTs, 229 DCD and 7267 donation after brain death recipients were analyzed. The frequency of DCD HT increased from 0.2% of all HT in 2019 to 6.4% in 2021 (P<0.001), and the number of centers performing DCD HT increased from 3 of 120 centers to 20 of 121 centers (P<0.001). DCD donors were more likely to be younger, male, and White. After propensity matching, 1-year survival was 92.5% for DCD versus 90.3% for donation after brain death (hazard ratio, 0.80 [95% CI, 0.44-1.43]; P=0.44). Among DCD HTs, increasing recipient age and waitlist time predicted 1-year mortality on univariable analysis. CONCLUSIONS Rates of DCD HT in the United States are increasing. This practice appears safe and feasible as mortality outcomes are comparable to donation after brain death. Although this study represents early adopting centers, outcomes of the experience for DCD HT in the United States is consistent with existing international data and encourages broader utilization of this practice.
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Affiliation(s)
- Jennie H Kwon
- Division of Cardiothoracic Surgery, Department of Surgery (J.H.K., A.D.G., K.S., B.W., Z.A.H., A.K.), Medical University of South Carolina, Charleston
| | - Alexander D Ghannam
- Division of Cardiothoracic Surgery, Department of Surgery (J.H.K., A.D.G., K.S., B.W., Z.A.H., A.K.), Medical University of South Carolina, Charleston
| | - Khaled Shorbaji
- Division of Cardiothoracic Surgery, Department of Surgery (J.H.K., A.D.G., K.S., B.W., Z.A.H., A.K.), Medical University of South Carolina, Charleston
| | - Brett Welch
- Division of Cardiothoracic Surgery, Department of Surgery (J.H.K., A.D.G., K.S., B.W., Z.A.H., A.K.), Medical University of South Carolina, Charleston
| | - Z A Hashmi
- Division of Cardiothoracic Surgery, Department of Surgery (J.H.K., A.D.G., K.S., B.W., Z.A.H., A.K.), Medical University of South Carolina, Charleston
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine (R.J.T.), Medical University of South Carolina, Charleston
| | - Arman Kilic
- Division of Cardiothoracic Surgery, Department of Surgery (J.H.K., A.D.G., K.S., B.W., Z.A.H., A.K.), Medical University of South Carolina, Charleston
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Meredith T, Scheuer S, Hoffman M, Joshi Y, Kathir K, Gunalingam B, Roy D, Wilson S, Jansz P, Macdonald P, Muller D. Coronary angiography of the ex-situ beating donor heart in a portable organ care system. Catheter Cardiovasc Interv 2022; 100:1252-1260. [PMID: 36321629 PMCID: PMC10091975 DOI: 10.1002/ccd.30455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine safety and feasibility of ex-situ coronary angiography. BACKGROUND To cater for the perpetually growing demand for heart donors, interest in donation following circulatory death (DCD) has been rekindled. Further pursuit of donor pool expansion has led to eligibility extension to "marginal" donors who are at higher risk of coronary artery disease (CAD). Excluding CAD in potentially eligible DCD donors, for whom ante-mortem angiography is commonly not permitted, is therefore challenging. Ex-situ coronary angiography serves as an ethical and feasible diagnostic tool to assess for preclusive CAD. METHODS We undertook a systematic review of the published literature and institutional retrospective review of case experience with ex-situ coronary angiography of donor hearts, supported by a portable organ care system. RESULTS Combined literature and institutional case review yielded nine total cases of ex-situ coronary angiography of donor human hearts plus one experimental porcine model. Of the eight cases of ex-situ coronary angiography performed at our institute, all were conducted without complication or injury to the allograft. Two thirds of reported human cases have proceeded to successful transplantation. CONCLUSIONS Diagnostic coronary angiography of the ex-situ beating donor heart is safe, feasible, and demonstrates novel clinical utility in mitigating subsequent transplantation of unsuitable allografts. In the setting of suspected coronary atherosclerosis of the donor heart, which may preclude favorable transplantation outcomes, ex-situ coronary angiography should be considered at eligible transplant centers.
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Affiliation(s)
- Thomas Meredith
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah Scheuer
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Heart and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Michael Hoffman
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Yashutosh Joshi
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Heart and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Krishna Kathir
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Brendan Gunalingam
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - David Roy
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Stephanie Wilson
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Paul Jansz
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Heart and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Peter Macdonald
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Heart and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - David Muller
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Ferrera R, Védère M, Lo-Grasso M, Augeul L, Chouabe C, Bidaux G, Baetz D. Postconditioning by Delayed Administration of Ciclosporin A: Implication for Donation after Circulatory Death (DCD). Int J Mol Sci 2022; 23:12858. [PMID: 36361649 PMCID: PMC9657531 DOI: 10.3390/ijms232112858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022] Open
Abstract
Heart transplantation is facing a shortage of grafts. Donation after Circulatory Death (DCD) would constitute a new potential of available organs. In the present work, we aimed to evaluate whether Postconditioning (ischemic or with ciclosporin-A (CsA)) could reduce ischemia-reperfusion injury in a cardiac arrest model when applied at the start of reperfusion or after a delay. An isolated rat heart model was used as a model of DCD. Hearts were submitted to a cardiac arrest of 40 min of global warm ischemia (37 °C) followed by 3 h of 4 °C-cold preservation, then 60 min reperfusion. Hearts were randomly allocated into the following groups: control, ischemic postconditioning (POST, consisting of two episodes each of 30 s ischemia and 30 s reperfusion at the onset of reperfusion), and CsA group (CsA was perfused at 250 nM for 10 min at reperfusion). In respective subgroups, POST and CsA were applied after a delay of 3, 10, and 20 min. Necrosis was lower in CsA and POST versus controls (p < 0.01) whereas heart functions were improved (p < 0.01). However, while the POST lost its efficacy if delayed beyond 3 min of reperfusion, CsA treatment surprisingly showed a reduction of necrosis even if applied after a delay of 3 and 10 min of reperfusion (p < 0.01). This cardioprotection by delayed CsA application correlated with better functional recovery and higher mitochondrial respiratory index. Furthermore, calcium overload necessary to induce mitochondrial permeability transition pore (MPTP) opening was similar in all cardioprotection groups, suggesting a crucial role of MPTP in this delayed protection of DCD hearts.
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Affiliation(s)
- René Ferrera
- University of Lyon, CARMEN Laboratory, INSERM, INRAE, Université Claude Bernard Lyon 1, 69500 Lyon, France
| | - Marie Védère
- University of Lyon, CARMEN Laboratory, INSERM, INRAE, Université Claude Bernard Lyon 1, 69500 Lyon, France
| | - Megane Lo-Grasso
- University of Lyon, CARMEN Laboratory, INSERM, INRAE, Université Claude Bernard Lyon 1, 69500 Lyon, France
| | - Lionel Augeul
- University of Lyon, CARMEN Laboratory, INSERM, INRAE, Université Claude Bernard Lyon 1, 69500 Lyon, France
| | - Christophe Chouabe
- University of Lyon, CARMEN Laboratory, INSERM, INRAE, Université Claude Bernard Lyon 1, 69500 Lyon, France
| | - Gabriel Bidaux
- University of Lyon, CARMEN Laboratory, INSERM, INRAE, Université Claude Bernard Lyon 1, 69500 Lyon, France
| | - Delphine Baetz
- University of Lyon, CARMEN Laboratory, INSERM, INRAE, Université Claude Bernard Lyon 1, 69500 Lyon, France
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63
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Cameli M, Pastore MC, Campora A, Lisi M, Mandoli GE. Donor shortage in heart transplantation: How can we overcome this challenge? Front Cardiovasc Med 2022; 9:1001002. [PMID: 36324743 PMCID: PMC9618685 DOI: 10.3389/fcvm.2022.1001002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/29/2022] [Indexed: 01/13/2024] Open
Affiliation(s)
- Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alessandro Campora
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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D'Alessandro DA, Wolfe SB, Osho AA, Drezek K, Prario MN, Rabi SA, Michel E, Tsao L, Coglianese E, Doucette M, Zlotoff DA, Newton-Cheh C, Thomas SS, Ton VK, Sutaria N, Schoenike MW, Christ AM, Paneitz DC, Madsen JC, Pierson R, Lewis GD. Hemodynamic and Clinical Performance of Hearts Donated After Circulatory Death. J Am Coll Cardiol 2022; 80:1314-1326. [PMID: 36175050 DOI: 10.1016/j.jacc.2022.07.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/27/2022] [Accepted: 07/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Donor organ demand continues to outpace supply in heart transplantation. Utilization of donation after circulatory death (DCD) hearts could significantly increase heart donor availability for patients with advanced heart failure. OBJECTIVES The purpose of this study was to describe hemodynamic and clinical profiles of DCD hearts in comparison to standard of care (SOC) hearts donated after brain death (DBD). METHODS This single-center retrospective cohort study of consecutive heart transplant recipients analyzed right heart catheterization measurements, inotrope scores, echocardiograms, and clinical outcomes between DCD and DBD heart recipients. RESULTS Between April 2016 and February 2022, 47 DCD and 166 SOC hearts were transplanted. Median time from DCD consent to transplant was significantly shorter compared with SOC waiting list time (17 days [6-28 days] vs 70 days [23-240 days]; P < 0.001). Right heart function was significantly impaired in DCD recipients compared with SOC recipients 1 week post-transplant (higher median right atrial pressure (10 mm Hg [8-13 mm Hg] vs 7 mm Hg [5-11 mm Hg]; P < 0.001), higher right atrial pressure to pulmonary capillary wedge pressure ratio (0.64 [0.54-0.82] vs 0.57 [0.43-0.73]; P = 0.016), and lower pulmonary arterial pulsatility index (1.66 [1.27-2.50] vs 2.52 [1.63-3.82]; P < 0.001), but was similar between groups by 3 weeks post-transplant. DCD and SOC recipient mortality was similar at 30 days (DCD 0 vs SOC 2%; P = 0.29) and 1 year post-transplant (DCD 3% vs SOC 8%; P = 0.16). CONCLUSIONS DCD heart utilization is associated with transient post-transplant right heart dysfunction and short-term clinical outcomes otherwise similar to transplantation using DBD hearts.
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Affiliation(s)
- David A D'Alessandro
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Stanley B Wolfe
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Asishana A Osho
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kamila Drezek
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Monica N Prario
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - S Alireza Rabi
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eriberto Michel
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lana Tsao
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin Coglianese
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meaghan Doucette
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel A Zlotoff
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher Newton-Cheh
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sunu S Thomas
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Van-Khue Ton
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nilay Sutaria
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark W Schoenike
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anastasia M Christ
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dane C Paneitz
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joren C Madsen
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard Pierson
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory D Lewis
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA. https://twitter.com/GLewisCardiol
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Hypothermia Alleviates Reductive Stress, a Root Cause of Ischemia Reperfusion Injury. Int J Mol Sci 2022; 23:ijms231710108. [PMID: 36077504 PMCID: PMC9456258 DOI: 10.3390/ijms231710108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Ischemia reperfusion injury is common in transplantation. Previous studies have shown that cooling can protect against hypoxic injury. To date, the protective effects of hypothermia have been largely associated with metabolic suppression. Since kidney transplantation is one of the most common organ transplant surgeries, we used human-derived renal proximal tubular cells (HKC8 cell line) as a model of normal renal cells. We performed a temperature titration curve from 37 °C to 22 °C and evaluated cellular respiration and molecular mechanisms that can counteract the build-up of reducing equivalents in hypoxic conditions. We show that the protective effects of hypothermia are likely to stem both from metabolic suppression (inhibitory component) and augmentation of stress tolerance (activating component), with the highest overlap between activating and suppressing mechanisms emerging in the window of mild hypothermia (32 °C). Hypothermia decreased hypoxia-induced rise in the extracellular lactate:pyruvate ratio, increased ATP/ADP ratio and mitochondrial content, normalized lipid content, and improved the recovery of respiration after anoxia. Importantly, it was observed that in contrast to mild hypothermia, moderate and deep hypothermia interfere with HIF1 (hypoxia inducible factor 1)-dependent HRE (hypoxia response element) induction in hypoxia. This work also demonstrates that hypothermia alleviates reductive stress, a conceptually novel and largely overlooked phenomenon at the root of ischemia reperfusion injury.
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66
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Quantitative stiffness assessment of cardiac grafts using ultrasound in a porcine model: A tissue biomarker for heart transplantation. EBioMedicine 2022; 83:104201. [PMID: 35932640 PMCID: PMC9358428 DOI: 10.1016/j.ebiom.2022.104201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Heart transplantation is the definitive treatment for many cardiovascular diseases. However, no ideal approach is established to evaluate heart grafts and it mostly relies on qualitative interpretation of surgeon based on the organ aspect including anatomy, color and manual palpation. In this study we propose to assess quantitatively the Shear Wave Velocity (SWV) using ultrasound as a biomarker of cardiac viability on a porcine model. Methods The SWV was assessed quantitatively using a clinical ultrasound elastography device (Aixplorer, Supersonics Imagine, France) linked to a robotic motorized arm (UR3, Universal Robots, Denmark) and the elastic anisotropy was obtained using a custom ultrasound research system. SWV was evaluated as function of time in two porcine heart model during 20h at controlled temperature (4°C). One control group (N = 8) with the heart removed and arrested by cold cardioplegia and immerged in a preservation solution. One ischemic group (N = 6) with the organ harvested after 30 min of in situ warm ischemia, to mimic a donation after cardiac death. Hearts graft were revived at two preservation times, at 4 h (N = 11) and 20 h (N = 10) and the parameters of the cardiac function evaluated. Findings On control hearts, SWV remained unchanged during the 4h of preservation. SWV increased significantly between 4 and 20h. For the ischemic group, SWV was found higher after 4h (3.04 +/- 0.69 vs 1.69+/-0.19 m/s, p = 0.007) and 20h (4.77+/-1.22 m/s vs 3.40+/-0.75 m/s, p = 0.034) of preservation with significant differences. A good correlation between SWV and cardiac function index was found (r2=0.88) and manual palpation score (r2=0.81). Interpretation Myocardial stiffness increase was quantified as a function of preservation time and harvesting conditions. The correlation between SWV and cardiac function index suggests that SWV could be used as a marker of graft viability. This technique may be transposed to clinical transplantation for assessing the graft viability during transplantation process. Funding FRM PME20170637799, Agence Biomédecine AOR Greffe 2017, ANR-18-CE18-0015.
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67
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Expanding Donor Heart Utilization Through Machine Perfusion Technologies. CURRENT TRANSPLANTATION REPORTS 2022. [DOI: 10.1007/s40472-022-00375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Abstract
Purpose of Review
Recent advances in donor heart preservation have allowed the utilization of hearts that would typically be discarded due to prolonged ischemic times or donation via the circulatory death pathway. This review will discuss recent advances in donor heart preservation including optimization of machine perfusion technologies and future strategies of potential benefit for the donor heart and transplant outcomes.
Recent Findings
Improvements in organ preservation strategies have enabled retrieval of donor hearts that were not ideal for static cold storage. Machine perfusion (normothermic and hypothermic) and normothermic regional perfusion have ultimately expanded the donor pool for adult heart transplantation. Xenotransplantation has also incorporated machine perfusion for porcine donor heart preservation.
Summary
Traditional static cold storage is feasible for non-complex donors and transplants. Machine perfusion has enabled increased donor heart utilization however optimal preservation strategies are dependent on the donor criteria, predicted ischemic times and surgical complexity.
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Bursill CA, Smith NJ, Palpant N, Tan I, Sunde M, Harvey RP, Lewis B, Figtree GA, Vandenberg JI. Don't Turn Off the Tap! The Importance of Discovery Science to the Australian Cardiovascular Sector and Improving Clinical Outcomes Into the Future. Heart Lung Circ 2022; 31:1321-1332. [PMID: 35961820 DOI: 10.1016/j.hlc.2022.06.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/01/2022] [Accepted: 06/10/2022] [Indexed: 10/15/2022]
Abstract
Despite significant advances in interventional and therapeutic approaches, cardiovascular disease (CVD) remains the leading cause of death and mortality. To lower this health burden, cardiovascular discovery scientists need to play an integral part in the solution. Successful clinical translation is achieved when built upon a strong foundational understanding of the disease mechanisms involved. Changes in the Australian funding landscape, to place greater emphasis on translation, however, have increased job insecurity for discovery science researchers and especially early-mid career researchers. To highlight the importance of discovery science in cardiovascular research, this review compiles six science stories in which fundamental discoveries, often involving Australian researchers, has led to or is advancing to clinical translation. These stories demonstrate the importance of the role of discovery scientists and the need for their work to be prioritised now and in the future. Australia needs to keep discovery scientists supported and fully engaged within the broader cardiovascular research ecosystem so they can help realise the next game-changing therapy or diagnostic approach that diminishes the burden of CVD on society.
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Affiliation(s)
- Christina A Bursill
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Faculty of Health and Medical Research, The University of Adelaide, Adelaide, SA, Australia; Australian Research Council (ARC) Centre of Excellence for Nanoscale BioPhotonics (CNBP).
| | - Nicola J Smith
- School of Medical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Nathan Palpant
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia
| | - Isabella Tan
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Melbourne, Vic, Australia; The George Institute of Global Health, Sydney, NSW, Australia
| | - Margaret Sunde
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The University of Sydney Nano Institute, The University of Sydney, Sydney, NSW, Australia
| | - Richard P Harvey
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia; School of Biotechnology and Biomolecular Science, UNSW Sydney, Sydney, NSW, Australia
| | - Benjamin Lewis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jamie I Vandenberg
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia
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Alamouti-fard E, Garg P, Wadiwala IJ, Yazji JH, Alomari M, Hussain MWA, Elawady MS, Jacob S. Normothermic Regional Perfusion is an Emerging Cost-Effective Alternative in Donation After Circulatory Death (DCD) in Heart Transplantation. Cureus 2022; 14:e26437. [PMID: 35800191 PMCID: PMC9246458 DOI: 10.7759/cureus.26437] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Abstract
In donation after circulatory death (DCD) organ transplantation, normothermic regional perfusion (NRP) restores oxygenated blood flow following cardiac arrest and reverses warm ischemia. Recently, NRP has also been used to help recover DCD hearts in addition to the abdominal organs. While DCD donation has increased the number of abdominal organs and lungs pool, it has not been able to increase the number of heart transplants, despite the fact that it has the potential to increase the number of heart transplants by 15-30%. Thoracoabdominal normothermic regional perfusion makes heart transplantation feasible and permits assessing heart function before an organ procurement without affecting the preservation of abdominal organs. NRP can be used in two ways for DCD donor heart transplants: normothermic regional perfusion followed by machine perfusion (NRP-MP) and normothermic regional perfusion followed by static cold storage (NRP-SCS). Normothermic regional perfusion is an emerging technology, a cost-effective alternative in donation after circulatory death (DCD), and will increase the pool of donors in heart transplantation.
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Alomari M, Garg P, Yazji JH, Wadiwala IJ, Alamouti-fard E, Hussain MWA, Elawady MS, Jacob S. Is the Organ Care System (OCS) Still the First Choice With Emerging New Strategies for Donation After Circulatory Death (DCD) in Heart Transplant? Cureus 2022; 14:e26281. [PMID: 35754437 PMCID: PMC9229932 DOI: 10.7759/cureus.26281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 12/14/2022] Open
Abstract
The scarcity of donor hearts continues to be a challenge in transplants for advanced heart failure patients. With an increasing number of patients on the waiting list for a heart transplant, the discrepancy in the number between donors and recipients is gradually increasing and poses a new challenge that plagues the healthcare systems when it comes to the heart. Several technologies have been developed to expand the donor pool in recent years. One such method is the organ care system (OCS). The standard method of organ preservation is the static cold storage (SCS) method which allows up to four hours of safe preservation of the heart. However, beyond four hours of cold ischemia, the incidence of primary graft dysfunction increases significantly. OCS keeps the heart perfused close to the physiological state beyond the four hours with superior results, which allows us to travel further and longer distances, leading to expansion in the donor pool. In this review, we discuss the OCS system, its advantages, and shortcomings.
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71
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Chen Z, Wang T, Chen C, Zhao Q, Ma Y, Guo Y, Hong X, Yu J, Huang C, Ju W, Chen M, He X. Transplantation of Extended Criteria Donor Livers Following Continuous Normothermic Machine Perfusion Without Recooling. Transplantation 2022; 106:1193-1200. [PMID: 34495016 PMCID: PMC9128617 DOI: 10.1097/tp.0000000000003945] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/10/2021] [Accepted: 07/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traditional liver transplant strategies with cold preservation usually result in ischemia-reperfusion injury (IRI) to the donor liver. Regular normothermic machine perfusion (NMP) donor livers suffer IRI twice. Here, we aimed to introduce a novel technique called continuous NMP without recooling to avoid a second IRI and its application in livers from extended criteria donors. METHODS Seven donor livers transplanted following continuous NMP without recooling, 7 donor livers transplanted following standard NMP, and 14 livers under static cold storage (SCS) were included in this study. Perioperative outcomes were recorded and analyzed between groups. RESULTS During the NMP without a recooling procedure, all livers cleared lactate quickly to normal levels in a median time of 100 min (interquartile range, 60-180) and remained stable until the end of perfusion. In the NMP without recooling and standard NMP groups, posttransplant peak aspartate aminotransferase and alanine aminotransferase levels were both significantly lower than those in the SCS group (P = 0.0015 and 0.016, respectively). The occurrence rate of early allograft dysfunction was significantly lower in the NMP without recooling group than in the SCS group (P = 0.022), whereas there was no difference in the NMP group with or without recooling (P = 0.462). CONCLUSIONS Our pilot study revealed a novel technique designed to avoid secondary IRI. This novel technique is shown to have at least a comparable effect on the standard NMP, although more data are needed to show its superiority in the future.
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Affiliation(s)
- Zhitao Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Tielong Wang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Chuanbao Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Qiang Zhao
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Yihao Ma
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Yiwen Guo
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Xitao Hong
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Jia Yu
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Changjun Huang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Weiqiang Ju
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Maogen Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
| | - Xiaoshun He
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People’s Republic of China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, People’s Republic of China
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Normothermic Ex Situ Heart Perfusion With the Organ Care System for Cardiac Transplantation: A Meta-analysis. Transplantation 2022; 106:1745-1753. [PMID: 35618669 DOI: 10.1097/tp.0000000000004167] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart transplantation (HTx) is, at present, the most effective therapy for end-stage heart failure patients; however, the number of patients on the waiting list is rising globally, further increasing the gap between demand and supply of donors for HTx. First studies using the Organ Care System (OCS) for normothermic machine perfusion show promising results yet are limited in sample size. This article presents a meta-analysis of heart donation either after brain death (OCS-DBD) or circulatory death (OCS-DCD) on using OCS versus static cold storage used for HTx. METHODS A systematic literature search was performed for articles discussing the use of normothermic ex situ heart perfusion in adult patients. Thirty-day survival outcomes were pooled, and odds ratios were calculated using random-effects models. Long-term survival was visualized with Kaplan-Meier curves, hazard ratios were calculated and pooled using fixed-effects models, and secondary outcomes were analyzed. RESULTS A total of 12 studies were included, with 741 patients undergoing HTx, of which 260 with the OCS (173 DBD and 87 DCD). No differences were found between the 3 groups for early and late survival outcomes or for secondary outcomes. CONCLUSIONS OCS outcomes, for both DBD and DCD hearts, appeared similar as for static cold storage. Therefore, OCS is a safe and effective technique to enlarge the cardiac donor pool in both DBD and DCD, with additional benefits for long-distance transport and surgically complex procedures.
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73
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Laurence C, Nachum E, Henwood S, Berman MM, Large MSR, Messer MS, Kaul MP, Baxter J, Quigley R, Osman M, Muthialu MN, Davies MB, Bohuta ML, Kostolny MM, BurchChB M, Fenton M, Andrews R, Thiruchelvam T, Hoskote A, Simmonds J. Pediatric heart transplantation following donation after circulatory death, distant procurement, and ex-situ perfusion. J Heart Lung Transplant 2022; 41:1104-1113. [DOI: 10.1016/j.healun.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022] Open
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Feizpour CA, Gauntt K, Patel MS, Carrico B, Vagefi PA, Klassen D, MacConmara M. The impact of machine perfusion of the heart on warm ischemia time and organ yield in donation after circulatory death. Am J Transplant 2022; 22:1451-1458. [PMID: 35007385 DOI: 10.1111/ajt.16952] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/10/2021] [Accepted: 01/03/2022] [Indexed: 01/25/2023]
Abstract
Successful normothermic machine perfusion of heart allografts (MPH) has led to rapid growth in transplantation of donation after circulatory death (DCD) heart allografts but has introduced complexity in the procurement process. This study examines the impact of MPH use in DCD procurements on warm ischemia time (WIT) and organ yield. DCD procurements from 2019 to 2020 were identified using the OPTN database. Procurements with and without the use of MPH were compared using propensity score matching. Observed to expected (O:E) yield ratios were calculated, where the expected values were obtained using the models developed by the Scientific Registry of Transplant Recipients. In total, 1237 DCD procurements met inclusion criteria (MPH: 109 and control: 1128). After PSM, no difference was found between groups in median total WIT (24.0 min vs. 24.0 min, p = .89), but the MPH group demonstrated shorter median operative WIT (circulatory arrest to cross-clamp; 8.7 min vs. 10.9 min, p = .003). The overall organ yield of DCD heart donors was observed to be 33% higher than expected (O:E 1.33; 95% CI: 1.22-1.45). Observed yield of non-heart organs was not significantly different from expected for liver, kidney, lung, and pancreas grafts. MPH use in DCD procurements does not lead to delays in WIT and does not negatively affect organ yield of other concurrently procured organs.
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Affiliation(s)
- Cyrus A Feizpour
- Division of Surgical Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Katrina Gauntt
- United Network for Organ Sharing, Richmond, Virginia, USA
| | - Madhukar S Patel
- Division of Surgical Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Bob Carrico
- United Network for Organ Sharing, Richmond, Virginia, USA
| | - Parsia A Vagefi
- Division of Surgical Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - David Klassen
- United Network for Organ Sharing, Richmond, Virginia, USA
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75
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Chen Q, Singer-Englar T, Kobashigawa JA, Roach A, Emerson D, Megna D, Ramzy D, Catarino P, Patel JK, Kittleson M, Czer L, Chikwe J, Esmailian F. Long-term outcomes after heart transplantation using ex vivo allograft perfusion in standard risk donors: A single-center experience. Clin Transplant 2022; 36:e14591. [PMID: 35030278 PMCID: PMC11144456 DOI: 10.1111/ctr.14591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Organ Care System (OCS) is an ex vivo perfusion platform for donor heart preservation. Short/mid-term post-transplant outcomes after its use are comparable to standard cold storage (CS). We evaluated long-term outcomes following its use. METHODS Between 2011 and 2013, 38 patients from a single center were randomized as a part of the PROCEED II trial to receive allografts preserved with CS (n = 19) or OCS (n = 19). Endpoints included 8-year survival, survival free from graft-related deaths, freedom from cardiac allograft vasculopathy (CAV), non-fatal major adverse cardiac events (NF-MACE), and rejections. RESULTS Eight-year survival was 57.9% in the OCS group and 73.7% in the CS group (p = .24). Freedom from CAV was 89.5% in the OCS group and 67.8% in the CS group (p = .13). Freedom from NF-MACE was 89.5% in the OCS group and 67.5% in the CS group (p = .14). Eight-year survival free from graft-related death was equivalent between the two groups (84.2% vs. 84.2%, p = .93). No differences in rejection episodes were observed (all p > .5). CONCLUSIONS In select patients receiving OCS preserved allografts, late post-transplant survival trended lower than those transplanted with an allograft preserved with CS. This is based on a small single-center series, and larger numbers are needed to confirm these findings.
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Affiliation(s)
- Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tahli Singer-Englar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon A. Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amy Roach
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dominick Megna
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Danny Ramzy
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Pedro Catarino
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jignesh K. Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michelle Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lawrence Czer
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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76
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Sánchez‐Cámara S, Asensio‐López MC, Royo‐Villanova M, Soler F, Jara‐Rubio R, Garrido‐Peñalver JF, Pinar E, Hernández‐Vicente Á, Hurtado JA, Lax A, Pascual‐Figal DA. Critical warm ischemia time point for cardiac donation after circulatory death. Am J Transplant 2022; 22:1321-1328. [PMID: 35114047 PMCID: PMC9303247 DOI: 10.1111/ajt.16987] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 01/25/2023]
Abstract
Donation after circulatory death (DCD) represents a promising opportunity to overcome the relative shortage of donors for heart transplantation. However, the necessary period of warm ischemia is a concern. This study aims to determine the critical warm ischemia time based on in vivo biochemical changes. Sixteen DCD non-cardiac donors, without cardiovascular disease, underwent serial endomyocardial biopsies immediately before withdrawal of life-sustaining therapy (WLST), at circulatory arrest (CA) and every 2 min thereafter. Samples were processed into representative pools to assess calcium homeostasis, mitochondrial function and cellular viability. Compared to baseline, no significant deterioration was observed in any studied parameter at the time of CA (median: 9 min; IQR: 7-13 min; range: 4-19 min). Ten min after CA, phosphorylation of cAMP-dependent protein kinase-A on Thr197 and SERCA2 decreased markedly; and parallelly, mitochondrial complex II and IV activities decreased, and caspase 3/7 activity raised significantly. These results did not differ when donors with higher WLST to CA times (≥9 min) were analyzed separately. In human cardiomyocytes, the period from WLST to CA and the first 10 min after CA were not associated with a significant compromise in cellular function or viability. These findings may help to incorporate DCD into heart transplant programs.
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Affiliation(s)
- Silvia Sánchez‐Cámara
- Biomedical Research Institute Virgen de la Arrixaca (IMIB‐Arrixaca)MurciaSpain,Intensive Medicine ServiceHospital Virgen de la ArrixacaMurciaSpain
| | - Mari C. Asensio‐López
- Biomedical Research Institute Virgen de la Arrixaca (IMIB‐Arrixaca)MurciaSpain,Medicine DepartmentUniversity of MurciaMurciaSpain
| | - Mario Royo‐Villanova
- Biomedical Research Institute Virgen de la Arrixaca (IMIB‐Arrixaca)MurciaSpain,Intensive Medicine ServiceHospital Virgen de la ArrixacaMurciaSpain,Transplant Coordination UnitHospital Virgen de la ArrixacaMurciaSpain
| | - Fernando Soler
- Biochemistry and Molecular Biology DepartmentUniversity of MurciaMurciaSpain
| | - Rubén Jara‐Rubio
- Biomedical Research Institute Virgen de la Arrixaca (IMIB‐Arrixaca)MurciaSpain,Intensive Medicine ServiceHospital Virgen de la ArrixacaMurciaSpain
| | | | - Eduardo Pinar
- Biomedical Research Institute Virgen de la Arrixaca (IMIB‐Arrixaca)MurciaSpain,Medicine DepartmentUniversity of MurciaMurciaSpain
| | - Álvaro Hernández‐Vicente
- Biomedical Research Institute Virgen de la Arrixaca (IMIB‐Arrixaca)MurciaSpain,Medicine DepartmentUniversity of MurciaMurciaSpain
| | | | - Antonio Lax
- Biomedical Research Institute Virgen de la Arrixaca (IMIB‐Arrixaca)MurciaSpain,Medicine DepartmentUniversity of MurciaMurciaSpain
| | - Domingo A. Pascual‐Figal
- Biomedical Research Institute Virgen de la Arrixaca (IMIB‐Arrixaca)MurciaSpain,Medicine DepartmentUniversity of MurciaMurciaSpain,Centro Nacional de Investigaciones Cardiovasculares (CNIC)MadridSpain,CIBERCVMadridSpain
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77
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Crespo-Leiro MG, Costanzo MR, Gustafsson F, Khush KK, Macdonald PS, Potena L, Stehlik J, Zuckermann A, Mehra MR. Heart transplantation: focus on donor recovery strategies, left ventricular assist devices, and novel therapies. Eur Heart J 2022; 43:2237-2246. [PMID: 35441654 DOI: 10.1093/eurheartj/ehac204] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 04/06/2022] [Indexed: 12/18/2022] Open
Abstract
Heart transplantation is advocated in selected patients with advanced heart failure in the absence of contraindications. Principal challenges in heart transplantation centre around an insufficient and underutilized donor organ pool, the need to individualize titration of immunosuppressive therapy, and to minimize late complications such as cardiac allograft vasculopathy, malignancy, and renal dysfunction. Advances have served to increase the organ donor pool by advocating the use of donors with underlying hepatitis C virus infection and by expanding the donor source to use hearts donated after circulatory death. New techniques to preserve the donor heart over prolonged ischaemic times, and enabling longer transport times in a safe manner, have been introduced. Mechanical circulatory support as a bridge to transplantation has allowed patients with advanced heart failure to avoid progressive deterioration in hepato-renal function while awaiting an optimal donor organ match. The management of the heart transplantation recipient remains a challenge despite advances in immunosuppression, which provide early gains in rejection avoidance but are associated with infections and late-outcome challenges. In this article, we review contemporary advances and challenges in this field to focus on donor recovery strategies, left ventricular assist devices, and immunosuppressive monitoring therapies with the potential to enhance outcomes. We also describe opportunities for future discovery to include a renewed focus on long-term survival, which continues to be an area that is under-studied and poorly characterized, non-human sources of organs for transplantation including xenotransplantation as well as chimeric transplantation, and technology competitive to human heart transplantation, such as tissue engineering.
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Affiliation(s)
- Maria Generosa Crespo-Leiro
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomedica A Coruña (INIBIC), Centro de Investigacion Biomedica en Red Cardiovascular (CIBERCV), As Xubias 84, 15006 A Coruña, Spain
| | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Mandeep R Mehra
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
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78
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Truby LK, Casalinova S, Patel CB, Agarwal R, Holley CL, Mentz RJ, Milano C, Bryner B, Schroder JN, Devore AD. Donation After Circulatory Death in Heart Transplantation: History, Outcomes, Clinical Challenges, and Opportunities to Expand the Donor Pool. J Card Fail 2022; 28:1456-1463. [PMID: 35447338 DOI: 10.1016/j.cardfail.2022.03.353] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/15/2022]
Abstract
Heart transplantation remains the gold-standard therapy for end-stage heart failure; the expected median survival range is 12-13 years. More than 30,000 heart transplants have been performed globally in the past decade alone. With advances in medical and surgical therapies for heart failure, including durable left ventricular assist devices, an increasing number of patients are living with end-stage disease. Last year alone, more than 2500 patients were added to the heart-transplant waitlist in the United States. Despite recent efforts to expand the donor pool, including an increase in transplantation of hepatitis C-positive and extended-criteria donors, supply continues to fall short of demand. Donation after circulatory death (DCD), defined by irreversible cardiopulmonary arrest rather than donor brain death, is widely used in other solid-organ transplants, including kidney and liver, but has not been widely adopted in heart transplantation. However, resurging interest in DCD donation and the introduction of ex vivo perfusion technology has catalyzed recent clinical trials and the development of DCD heart-transplantation programs. Herein, we review the history of DCD heart transplantation, describe the currently used procurement protocols for it and examine clinical challenges and outcomes of such a procedure.
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Affiliation(s)
- Lauren K Truby
- From the Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Sarah Casalinova
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Chetan B Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Richa Agarwal
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Christopher L Holley
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Carmelo Milano
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Benjamin Bryner
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jacob N Schroder
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Adam D Devore
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
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79
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Seth AK, Mohanka R, Navin S, Gokhale AGK, Sharma A, Kumar A, Ramachandran B, Balakrishnan KR, Mirza D, Mehta D, Zirpe KG, Dhital K, Sahay M, Simha S, Sundaram R, Pandit R, Mani RK, Gursahani R, Gupta S, Kute VB, Shroff S. Organ Donation after Circulatory Determination of Death in India: A Joint Position Paper. Indian J Crit Care Med 2022; 26:421-438. [PMID: 35656056 PMCID: PMC9067489 DOI: 10.5005/jp-journals-10071-24198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Avnish K Seth
- Manipal Organ Sharing and Transplant (MOST), Manipal Hospital, New Delhi, India
| | - Ravi Mohanka
- Department of Liver Transplant and HPB Surgery, Reliance Foundation Hospital, Mumbai, Maharashtra, India
- Ravi Mohanka, Department of Liver Transplant and HPB Surgery, Reliance Foundation Hospital, Mumbai, Maharashtra, India, Phone: +91 7506668666, e-mail:
| | | | | | - Ashish Sharma
- Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Kumar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Bala Ramachandran
- Department of Pediatric Intensive Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | | | - Darius Mirza
- University of Birmingham, United Kingdom and Apollo Hospitals, Navi Mumbai, Maharashtra, India
| | | | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Kumud Dhital
- Department of Heart and Lung Transplantation, SS Sparsh Hospital, Bengaluru, Karnataka, India
| | - Manisha Sahay
- Osmania Medical College and Hospital, Hyderabad, Telangana, India
| | - Srinagesh Simha
- Department of Palliative Care, Karunashraya, Bengaluru, Karnataka, India
| | | | | | - Raj K Mani
- Department of Critical Care and Pulmonology, Yashoda Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Roop Gursahani
- Department of Neurology, PD Hinduja National Hospital, Mumbai, Maharashtra, India
| | - Subash Gupta
- Max Centre for Liver and Biliary Sciences, New Delhi, India
| | - Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Sunil Shroff
- Madras Medical Mission, Chennai, Tamil Nadu, India
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80
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Qin G, Jernryd V, Sjöberg T, Steen S, Nilsson J. Machine Perfusion for Human Heart Preservation: A Systematic Review. Transpl Int 2022; 35:10258. [PMID: 35401041 PMCID: PMC8983812 DOI: 10.3389/ti.2022.10258] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 01/02/2023]
Abstract
Currently, static cold storage (SCS) of hearts from donations after brainstem death remains the standard clinically. However, machine perfusion (MP) is considered an approach for donor organ management to extend the donor pool and/or increase the utilization rate. This review summarizes and critically assesses the available clinical data on MP in heart transplantation. We searched Medline (PubMed), Cochrane, Embase, and clinicaltrials.gov, along with reference lists of the included publications and identified 40 publications, including 18 articles, 17 conference abstracts, and five ongoing clinical trials. Two types of MP were used: hypothermic MP (HMP) and normothermic MP (NMP). Three studies evaluated HMP, and 32 evaluated NMP. Independent of the system, MP resulted in clinical outcomes comparable to traditional SCS. However, NMP seemed especially beneficial for high-risk cases and donation after circulatory death (DCD) hearts. Based on currently available data, MP is non-inferior to standard SCS. Additionally, single-centre studies suggest that NMP could preserve the hearts from donors outside standard acceptability criteria and DCD hearts with comparable results to SCS. Finally, HMP is theoretically safer and simpler to use than NMP. If a machine malfunction or user error occurs, NMP, which perfuses a beating heart, would have a narrower margin of safety. However, further well-designed studies need to be conducted to draw clear conclusions.
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Affiliation(s)
- Guangqi Qin
- Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Victoria Jernryd
- Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Trygve Sjöberg
- Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Stig Steen
- Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Johan Nilsson
- Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University and Skane University Hospital, Lund, Sweden
- Department of Translational Medicine, Thoracic Surgery and Bioinformatics, Lund University, Lund, Sweden
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81
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Machine Perfusion of the Human Heart. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This brief communication about machine perfusion of potential human donor hearts describes its historical development. Included in the review are both the isolated perfusion of donor hearts retrieved from heart beating and non-heart-beating donors. Additionally, some detail of in-situ (within the donor body) normothermic regional reperfusion of the heart and other organs is given. This only applies to the DCD donor heart. Similarly, some detail of ex-situ (outside the body) heart perfusion is offered. This article covers the entire history of the reperfusion of donor hearts. It takes us up to the current day describing 6 years follow-up of these donor machine perfused hearts. These clinical results appear similar to the outcomes of heart beating donors if reperfusion is managed within 30 min of normothermic circulatory determined death. Future developments are also offered. These are 3-fold and include: i. the pressing need for objective markers of the clinical outcome after transplantation, ii. the wish for isolated heart perfusion leading to improvement in donor heart quality, and iii. a strategy to safely lengthen the duration of isolated heart perfusion.
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82
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Cheema FH, Rajagopal K. Swimming in the Deep (or is it Shallow?) end of the Donor Pool! Ann Thorac Surg 2022; 114:683. [PMID: 35247340 DOI: 10.1016/j.athoracsur.2022.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/13/2022] [Accepted: 02/19/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Faisal H Cheema
- Department of Clinical Sciences, University of Houston College of Medicine, Houston Heart, HCA Houston Healthcare
| | - Keshava Rajagopal
- Department of Clinical Sciences, University of Houston College of Medicine, Houston Heart, HCA Houston Healthcare.
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83
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Eixerés-Esteve A, Pérez-De la Sota E, Cortina-Romero JM. Métodos de preservación: más allá de la nevera. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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84
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HOLM AM, COURTWRIGHT A, OLLAND A, ZUCKERMANN A, RAEMDONCK DVAN. ISHLT Position Paper on Thoracic Organ Transplantation in Controlled Donation after Circulatory Determination of Death (cDCD). J Heart Lung Transplant 2022; 41:671-677. [DOI: 10.1016/j.healun.2022.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 01/12/2023] Open
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Cholyway R, Akande O, Mauro AG, Mezzaroma E, Wang R, Kenning K, Toldo S, Quader M. Assessment of Machine Perfusion Conditions for the Donation After Circulatory Death Heart Preservation. Artif Organs 2022; 46:1346-1357. [PMID: 35167122 PMCID: PMC9307000 DOI: 10.1111/aor.14208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/29/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
Background Donation after circulatory death (DCD) hearts requires machine perfusion preservation, the conditions of which are not well defined. Methods To achieve this, rat hearts were procured following a DCD or control beating‐heart donation (CBD) model, and perfused for 60 min with one of three machine perfusion solutions—St. Thomas (ST), University of Wisconsin (UW), or Polyethylene Glycol‐20k (PEG)—at one of two temperatures, 4°C or 15°C. At 15‐min intervals, perfusion pressure was measured as a marker of vascular resistance. Colored microspheres were added to capture the distribution of perfusate into the metabolically active sub‐endocardium, and the eluate was collected for troponin assays. Analyses compared groups using Wilcoxon rank‐sum and ANOVA. Results Perfusion pressure was significantly higher for DCD than CBD hearts at 15°C regardless of solutions. The lowest rise in perfusion pressure over time was observed with PEG at 15°C. Except for PEG at 15°C, ST and UW solutions at 4 or 15°C had decreased sub‐endocardial perfusion in DCD hearts. Troponin release from DCD hearts with UW and PEG solutions was comparable to CBD hearts but was significantly higher with ST solution at 15°C. Conclusions Optimal preservation conditions for DCD hearts were observed with PEG machine perfusion solution at 15°C.
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Affiliation(s)
- Renee Cholyway
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Oluwatoyin Akande
- Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Adolfo Gabriele Mauro
- Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, VA, USA.,Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Eleonora Mezzaroma
- Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, VA, USA.,Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Rui Wang
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Kristine Kenning
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Stefano Toldo
- Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, VA, USA.,Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mohammed Quader
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.,Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, VA, USA.,McGuire Veterans Administration Medical Center, Richmond, VA, USA
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86
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Ex-Vivo Preservation with the Organ Care System in High Risk Heart Transplantation. Life (Basel) 2022; 12:life12020247. [PMID: 35207534 PMCID: PMC8877453 DOI: 10.3390/life12020247] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Ex vivo organ perfusion is an advanced preservation technique that allows graft assessment and extended ex situ intervals. We hypothesized that its properties might be especially beneficial for high-risk recipients and/or donors with extended criteria. Methods: We reviewed the outcomes of 119 consecutive heart transplant patients, which were divided into two groups: A (OCS) vs. B (conventional). Ex vivo organ perfusion was performed using the Organ Care System (OCS). Indications for OCS-usage were expected ischemic time of >4 h or >2 h plus given extended donor criteria. Results: Both groups included mostly redo cases (A: 89.7% vs. B: 78.4%; p = 0.121). Incidences of donors with previous cardiac arrest (%) (A: 32.4 vs. B: 22.2; p < 0.05) or LV-hypertrophy (%) (A: 19.1 vs. B: 8.3; p = 0.119) were also increased in Group A. Ex situ time (min) was significantly longer in Group A (A: 381 (74) vs. B: 228 (43); p < 0.05). Ventilation time (days) (A: 10.0 (19.9) vs. B: 24.3 (43.2); p = 0.057), postoperative need for ECLS (%) (A: 25.0 vs. B: 39.2; p = 0.112) and postoperative dialysis (chronic) (%) (A: 4.4 vs. B: 27.5; p < 0.001) were numerically better in the OCS group, without any difference in the occurrence of early graft rejection. The 30-d-survival (A: 92.4% vs. B: 90.2%; p = 0.745) and mid-term survival were statistically not different between both groups. Conclusions: OCS heart allowed safe transplantation of surgically complex recipients with excellent one-year outcomes, despite long preservation times and unfavourable donor characteristics. Furthermore, we observed trends towards decreased ventilation times and fewer ECLS treatments. In times of reduced organ availability and increasing recipient complexity, OCS heart is a valuable instrument that enables otherwise infeasible allocations and contributes to increase surgical safety.
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87
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Villar-García S, Martín-López CE, Pérez-Redondo M, Hernández-Pérez FJ, Martínez-López D, de Villarreal-Soto JE, Ríos-Rosado EC, Vera-Puente B, Ospina-Mosquera VM, Serrano-Fiz S, Forteza-Gil A. Donación en asistolia controlada: cómo iniciar un programa. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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88
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El-Sayed Ahmed MM, Jacob S, Landolfo KP. Commentary: Donation after circulatory death (DCD) transplantation-something old is new again (and better). JTCVS Tech 2022; 11:57-58. [PMID: 35169737 PMCID: PMC8828957 DOI: 10.1016/j.xjtc.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Magdy M. El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
- Department of Surgery, Zagazig University Faculty of Human Medicine, Zagazig, Egypt
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Kevin P. Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
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89
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Feizpour CA, Hoffman J, Patel MS, Wang B, Hwang C, Balsara K, Shah A, Shah JA, Hanish SI, Vagefi PA, MacConmara M. Simultaneous ex vivo normothermic preservation of liver and heart grafts from a donation after circulatory death donor. J Card Surg 2022; 37:1076-1079. [DOI: 10.1111/jocs.16269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/29/2021] [Accepted: 01/13/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Cyrus A. Feizpour
- Department of Surgery UT Southwestern Medical Center, Division of Surgical Transplantation Dallas Texas USA
| | - Jordan Hoffman
- Department of Cardiac Surgery Vanderbilt University Medical Center Nashville Tennessee USA
| | - Madhukar S. Patel
- Department of Surgery UT Southwestern Medical Center, Division of Surgical Transplantation Dallas Texas USA
| | - Benjamin Wang
- Department of Surgery UT Southwestern Medical Center, Division of Surgical Transplantation Dallas Texas USA
| | - Christine Hwang
- Department of Surgery UT Southwestern Medical Center, Division of Surgical Transplantation Dallas Texas USA
| | - Keki Balsara
- Department of Cardiac Surgery Vanderbilt University Medical Center Nashville Tennessee USA
| | - Ashish Shah
- Department of Cardiac Surgery Vanderbilt University Medical Center Nashville Tennessee USA
| | - Jigesh A. Shah
- Department of Surgery UT Southwestern Medical Center, Division of Surgical Transplantation Dallas Texas USA
| | - Steven I. Hanish
- Department of Surgery UT Southwestern Medical Center, Division of Surgical Transplantation Dallas Texas USA
| | - Parsia A. Vagefi
- Department of Surgery UT Southwestern Medical Center, Division of Surgical Transplantation Dallas Texas USA
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90
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Baran DA, Mohammed A, Macdonald P, Copeland H. Heart Transplant Donor Selection: Recent Insights. CURRENT TRANSPLANTATION REPORTS 2022. [DOI: 10.1007/s40472-022-00355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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91
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Cardiac Allograft Injuries: A Review of Approaches to a Common Dilemma, With Emphasis on Emerging Techniques. INTERNATIONAL JOURNAL OF HEART FAILURE 2022; 4:123-135. [PMID: 36262796 PMCID: PMC9383355 DOI: 10.36628/ijhf.2021.0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/15/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Clinical features of allograft injury are often unreliable, and context within the transplant journey is key. In the setting of post-transplant allograft dysfunction, the choice of initial investigation depends on clinical assessment and history. One of the major considerations is the time post transplantation in helping to decide a likely cause for allograft injury. Immediately post transplantation, it is important to consider donor factors (including donor demographics as well as immunological match), ischaemic times, surgical issues as well as early rejection. Clinical suspicion needs to remain high with variable presentations, including haemodynamic instability, arrhythmia, as well as left ventricular dysfunction. Symptoms of allograft dysfunction may include dyspnoea, exertional intolerance, dizziness / lightheadedness, palpitations, as well as right or left heart failure. In the coming weeks and months, endomyocardial biopsy and blood-based biomarkers may be helpful including high sensitivity troponin and donor-derived cell-free DNA. Molecular markers for rejection are hopeful, and may also be useful in non-ischaemic causes of allograft dysfunction. Screening remains important late post heart transplant due to variety of signs associated with rejection (early) and lack of typical anginal symptoms (later). New imaging modalities - especially cardiac magnetic resonance imaging, have been shown to be useful for assessing cause of allograft dysfunction including ischemia, infarction and rejection.
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92
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Shroff S, Seth A, Mohanka R, Navin S, Gokhale AK, Sharma A, Kumar A, Ramachandran B, Balakrishnan KR, Mirza D, Mehta D, Zirpe K, Dhital K, Sahay M, Simha S, Sundaram R, Pandit R, Mani R, Gursahani R, Gupta S, Kute V. Organ donation after circulatory determination of death in India: A joint position paper. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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93
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Abstract
PURPOSE OF REVIEW To highlight the current global experience with DCD heart transplantation and explore the evolution of, and compare preservation strategies; examine early clinical outcomes, and discuss the growing use of DCD donors as a new frontier in heart transplantation. RECENT FINDINGS The two strategies of DCD heart preservation include NMP using the OCS Heart and TA-NRP followed by either: NMP or CSS. Better understanding the limits of cold ischaemia following TA-NRP will aid in distant procurement. Asystolic warm ischaemia plays an important role in determining immediate post-operative graft function and potential need for mechanical support. Large volume DCD heart transplant units show no difference in survival between DCD and DBD donor heart transplants. In a previously non-utilised source of donor hearts, often viewed as an "unknown frontier" in heart transplantation, DCD hearts are a suitable alternative to brain-dead donor hearts and are likely to remain a permanent part of the heart transplantation landscape. Global uptake is currently increasing, and as understanding of preservation strategies and tolerable ischaemic times improve, utilisation of DCD hearts will continue to grow.
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94
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Madan S, Saeed O, Forest SJ, Goldstein DJ, Jorde UP, Patel SR. Feasibility and Potential Impact of Heart Transplantation From Adult Donors After Circulatory Death. J Am Coll Cardiol 2021; 79:148-162. [PMID: 34922742 DOI: 10.1016/j.jacc.2021.10.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND A shortage of donation after brain death (DBD) donors for heart transplantation (HT) persists. Recent improvements in organ procurement from donation after circulatory death (DCD) donors and promising early results of DCD-HTs from Europe and Australia have renewed interest in DCD-HT. OBJECTIVES The current study evaluated donor and recipient characteristics, early outcomes, and potential impact of adult DCD-HT in the United States. METHODS The United Network for Organ Sharing registry was used to identify and compare adult DCD donors based on their use for HT between January 2020 and February 2021. Adult DCD-HTs with available post-HT outcomes data were compared with contemporary adult DBD-HTs during study period using Cox-regression analysis and propensity-matching. RESULTS Of the 3,611 adult DCD donors referred during the study period, 136 were used for HT. DCD donors used for HT were younger (median age 29 years), and most were male (90%), and blood type O (79%). On comparing DCD-HT (n = 127) and DBD-HT (n = 2,961) meeting study criteria and with available data on post-HT outcomes, there was no significant difference in 30-day or 6-month mortality, primary graft failure up to 30 days, or other outcomes including in-hospital stroke, pacemaker insertion, hemodialysis, and post-HT length of hospital stay. Results were similar in propensity matched DCD-HT and DBD-HT cohorts. The number of potential adult DCD donors referred has increased substantially (n = 871 in 2010 to n = 3,045 in 2020), and the authors estimated that widespread adoption of DCD-HT could lead to approximately 300 additional adult HTs in the United States annually. CONCLUSIONS This preliminary analysis of adult DCD-HTs from the United States showed favorable early outcomes and suggested a potential for substantial increase in adult HT volumes with use of DCD donors.
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Affiliation(s)
- Shivank Madan
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Omar Saeed
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephen J Forest
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel J Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Snehal R Patel
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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95
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Bryner BS, Schroder JN, Milano CA. Heart transplant advances: Ex vivo organ-preservation systems. JTCVS OPEN 2021; 8:123-127. [PMID: 36004090 PMCID: PMC9390583 DOI: 10.1016/j.xjon.2021.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin S. Bryner
- Address for reprints: Benjamin S. Bryner, MD, DUMC 3867, Durham, NC 27710
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Rubio Muñoz JJ, Dominguez-Gil González B, Miñambres García E, Del Río Gallegos F, Pérez-Villares JM. Role of normothermic perfusion with ECMO in donation after controlled cardiac death in Spain. Med Intensiva 2021; 46:31-41. [PMID: 34794913 DOI: 10.1016/j.medine.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Abstract
Spain has become one of the most active countries in donation after controlled cardiac death, using normothermic abdominal perfusion with ECMO in more than 50% of all donors - a situation contributed to by the creation of mobile teams to support hospitals lacking this technology. The donation process must be respectful of the wishes and values of the patients and their relatives, especially if there is pre mortem manipulation, and the absence of cerebral perfusion should be guaranteed. The liver is the most benefited organ by reducing biliary complications as well as the loss of grafts. In renal transplantation, the technique could contribute to reduce the incidence of delayed graft function. In addition, the procedure is compatible with surgical rapid recovery in hypothermia when there is also lung donation. The future lies in the consolidation of cardiac donation by extending normothermic perfusion to the thoracic cavity.
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Affiliation(s)
- J J Rubio Muñoz
- Servicio de Medicina Intensiva, Unidad de Coordinación de Trasplantes, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | | | - E Miñambres García
- Coordinación Regional de Trasplantes de la Comunidad de Cantabria, Servicio de Medicina Intensiva del Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - F Del Río Gallegos
- Coordinación Regional de Trasplantes de la Comunidad de Madrid, Servicio de Medicina Intensiva del Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J M Pérez-Villares
- Coordinador Regional de Trasplantes de la Comunidad de Andalucía, Servicio de Medicina Intensiva del Hospital Universitario Virgen de las Nieves, Granada, Spain
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97
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Guo Z, Zhao Q, Huang S, Huang C, Wang D, Yang L, Zhang J, Chen M, Wu L, Zhang Z, Zhu Z, Wang L, Zhu C, Zhang Y, Tang Y, Sun C, Xiong W, Shen Y, Chen X, Xu J, Wang T, Ma Y, Hu A, Chen Y, Zhu X, Rong J, Cai C, Gong F, Guan X, Huang W, Ko DSC, Li X, Tullius SG, Huang J, Ju W, He X. Ischaemia-free liver transplantation in humans: a first-in-human trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 16:100260. [PMID: 34590063 PMCID: PMC8406025 DOI: 10.1016/j.lanwpc.2021.100260] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 12/25/2022]
Abstract
Background Ischaemia-reperfusion injury is considered an inevitable component of organ transplantation, compromising organ quality and outcomes. Although several treatments have been proposed, none has avoided graft ischaemia and its detrimental consequences. Methods Ischaemia-free liver transplantation (IFLT) comprises surgical techniques enabling continuous oxygenated blood supply to the liver of brain-dead donor during procurement, preservation, and implantation using normothermic machine perfusion technology. In this non-randomised study, 38 donor livers were transplanted using IFLT and compared to 130 conventional liver transplants (CLT). Findings Two recipients (5•3%) in the IFLT group experienced early allograft dysfunction, compared to 50•0% in patients receiving conventional transplants (absolute risk difference, 44•8%; 95% confidence interval, 33•6-55•9%). Recipients of IFLT had significantly reduced median (IQR) peak aspartate aminotransferase levels within the first week compared to CLT recipients (365, 238-697 vs 1445, 791-3244 U/L, p<0•001); likewise, median total bilirubin levels on day 7 were significantly lower (2•34, 1•39-4•09 mg/dL) in the IFLT group than in the CLT group (5•10, 1•90-11•65 mg/dL) (p<0•001). Moreover, IFLT recipients had a shorter median intensive care unit stay (1•48, 0•75-2•00 vs 1•81, 1•00-4•58 days, p=0•006). Both one-month recipient (97•4% vs 90•8%, p=0•302) and graft survival (97.4% vs 90•0%, p=0•195) were better for IFLT than CLT, albeit differences were not statistically significant. Subgroup analysis showed that the extended criteria donor livers transplanted using the IFLT technique yielded faster post-transplant recovery than did the standard criteria donor livers transplanted using the conventional approach. Interpretation IFLT provides a novel approach that may improve outcomes, and allow the successful utilisation of extended criteria livers. Funding This study was funded by National Natural Science Foundation of China, Guangdong Provincial Key Laboratory Construction Projection on Organ Donation and Transplant Immunology, and Guangdong Provincial international Cooperation Base of Science and Technology. Panel: Research in context.
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Affiliation(s)
- Zhiyong Guo
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Qiang Zhao
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Shanzhou Huang
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Changjun Huang
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Dongping Wang
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Lu Yang
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510080, China
| | - Maogen Chen
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Linwei Wu
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Zhiheng Zhang
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Zebin Zhu
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Linhe Wang
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Caihui Zhu
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Yixi Zhang
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Yunhua Tang
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Chengjun Sun
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Wei Xiong
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Yuekun Shen
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaoxiang Chen
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jinghong Xu
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Tielong Wang
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Yi Ma
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Anbin Hu
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Yinghua Chen
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Xiaofeng Zhu
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Jian Rong
- Department of Cardiopulmonary Bypass, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Changjie Cai
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Fengqiu Gong
- Operating Room and Anaesthesia Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiangdong Guan
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Wenqi Huang
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Dicken Shiu-Chung Ko
- Department of Surgery, Steward St. Elizabeth's Medical Centre, Tufts University School of Medicine, Boston, MA 02115, USA
| | - Xianchang Li
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Immunobiology and Transplant Science Centre, Houston Methodist Research Institute, Houston, Texas 77030, USA
| | - Stefan G Tullius
- Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jiefu Huang
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Department of Surgery, Peking Union Medical College Hospital, Beijing 100032, China
| | - Weiqiang Ju
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
| | - Xiaoshun He
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
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98
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Funamoto M, Pierson RN, Nguyen JH, D'Alessandro DA. Surgical and logistical concerns for ex vivo–based perfusion strategies for “donation after circulatory death” multiorgan recovery. JTCVS Tech 2021; 11:49-56. [PMID: 35169736 PMCID: PMC8828966 DOI: 10.1016/j.xjtc.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/04/2021] [Indexed: 12/02/2022] Open
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99
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Ma M, Sun Q, Li X, Deng G, Zhang Y, Yang Z, Han F, Huang Z, Fang Y, Liao T, Sun Q. Blockade of IL-6/IL-6R Signaling Attenuates Acute Antibody-Mediated Rejection in a Mouse Cardiac Transplantation Model. Front Immunol 2021; 12:778359. [PMID: 34777394 PMCID: PMC8581398 DOI: 10.3389/fimmu.2021.778359] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Acute antibody-mediated rejection (AAMR) is an important cause of cardiac allograft dysfunction, and more effective strategies need to be explored to improve allograft prognosis. Interleukin (IL)-6/IL-6R signaling plays a key role in the activation of immune cells including B cells, T cells and macrophages, which participate in the progression of AAMR. In this study, we investigated the effect of IL-6/IL-6R signaling blockade on the prevention of AAMR in a mouse model. We established a mouse model of AAMR for cardiac transplantation via presensitization of skin grafts and addition of cyclosporin A, and sequentially analyzed its features. Tocilizumab, anti-IL-6R antibody, and recipient IL-6 knockout were used to block IL-6/IL-6R signaling. We demonstrated that blockade of IL-6/IL-6R signaling significantly attenuated allograft injury and improved survival. Further mechanistic research revealed that signaling blockade decreased B cells in circulation, spleens, and allografts, thus inhibiting donor-specific antibody production and complement activation. Moreover, macrophage, T cell, and pro-inflammatory cytokine infiltration in allografts was also reduced. Collectively, we provided a highly practical mouse model of AAMR and demonstrated that blockade of IL-6/IL-6R signaling markedly alleviated AAMR, which is expected to provide a superior option for the treatment of AAMR in clinic.
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Affiliation(s)
- Maolin Ma
- Organ Transplantation Research Institute, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qipeng Sun
- Department of Kidney Transplantation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiujie Li
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Gengguo Deng
- Organ Transplantation Research Institute, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yannan Zhang
- Department of Kidney Transplantation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Zhe Yang
- Organ Transplantation Research Institute, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fei Han
- Organ Transplantation Research Institute, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhengyu Huang
- Organ Transplantation Research Institute, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Youqiang Fang
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tao Liao
- Department of Kidney Transplantation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Qiquan Sun
- Department of Kidney Transplantation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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100
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Large S, Messer S. Intra-corporeal recovery of the donor heart after circulatory-determined death followed by cold storage in clinical practice. Eur J Cardiothorac Surg 2021; 60:820-821. [PMID: 34347091 DOI: 10.1093/ejcts/ezab360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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