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Kaye DM, Kure CE, Wallinder A, McGiffin DC. Limitations of the Inotrope Score Use as a Measure of Primary Graft Dysfunction. J Heart Lung Transplant 2024:S1053-2498(24)01891-6. [PMID: 39396774 DOI: 10.1016/j.healun.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 10/01/2024] [Accepted: 10/03/2024] [Indexed: 10/15/2024] Open
Affiliation(s)
- David M Kaye
- Department of Cardiology, The Alfred, Melbourne, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne.
| | - Christina E Kure
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne
| | | | - David C McGiffin
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne; Critical Care Research Group, The Prince Charles Hospital, Brisbane; University of Queensland, Brisbane
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Joshi Y, Wang K, MacLean C, Villanueva J, Gao L, Watson A, Iyer A, Connellan M, Granger E, Jansz P, Macdonald P. The Rapidly Evolving Landscape of DCD Heart Transplantation. Curr Cardiol Rep 2024:10.1007/s11886-024-02148-w. [PMID: 39382782 DOI: 10.1007/s11886-024-02148-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2024] [Indexed: 10/10/2024]
Abstract
PURPOSE OF REVIEW To summarise current international clinical outcomes from donation after circulatory death heart transplantation (DCD-HT); discuss procurement strategies, their impact on outcomes and overall organ procurement; and identify novel approaches and future areas for research in DCD-HT. RECENT FINDINGS Globally, DCD-HT survival outcomes (regardless of procurement strategy) are comparable to heart transplantation from brain dead donors (BDD). Experience with normothermic machine perfusion sees improvement in rates of primary graft dysfunction. Techniques have evolved to reduce cold ischaemic exposure to directly procured DCD hearts, though controlled periods of cold ischaemia can likely be tolerated. There is interest in hypothermic machine perfusion (HMP) for directly procured DCD hearts, with promising early results. Survival outcomes are firmly established to be equivalent between BDD and DCD-HT. Procurement strategy (direct procurement vs. regional perfusion) remains a source of debate. Methods to improve allograft warm ischaemic tolerance are of interest and will be key to the uptake of HMP for directly procured DCD hearts.
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Affiliation(s)
- Yashutosh Joshi
- Heart Transplantation Unit, St Vincent's Hospital Sydney, 390 Victoria St., Darlinghurst, NSW, 2010, Australia.
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia.
- University of New South Wales, Randwick, NSW, Australia.
| | | | | | - Jeanette Villanueva
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
| | - Ling Gao
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
| | - Alasdair Watson
- Heart Transplantation Unit, St Vincent's Hospital Sydney, 390 Victoria St., Darlinghurst, NSW, 2010, Australia
| | - Arjun Iyer
- Heart Transplantation Unit, St Vincent's Hospital Sydney, 390 Victoria St., Darlinghurst, NSW, 2010, Australia
| | - Mark Connellan
- Heart Transplantation Unit, St Vincent's Hospital Sydney, 390 Victoria St., Darlinghurst, NSW, 2010, Australia
| | - Emily Granger
- Heart Transplantation Unit, St Vincent's Hospital Sydney, 390 Victoria St., Darlinghurst, NSW, 2010, Australia
| | - Paul Jansz
- Heart Transplantation Unit, St Vincent's Hospital Sydney, 390 Victoria St., Darlinghurst, NSW, 2010, Australia
| | - Peter Macdonald
- Heart Transplantation Unit, St Vincent's Hospital Sydney, 390 Victoria St., Darlinghurst, NSW, 2010, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
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3
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Vervoorn MT, Ballan EM, Kaffka Genaamd Dengler SE, Meijborg VMF, de Jager SCA, Van Wijk R, van der Kaaij NP. A Perspective on the Added Value of Red Blood Cells during Cardiac Hypothermic Oxygenated Perfusion. J Heart Lung Transplant 2024:S1053-2498(24)01879-5. [PMID: 39369969 DOI: 10.1016/j.healun.2024.09.025] [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: 04/17/2024] [Revised: 09/13/2024] [Accepted: 09/28/2024] [Indexed: 10/08/2024] Open
Abstract
Hypothermic oxygenated perfusion (HOPE) is an emerging technique for donor heart preservation that is currently being studied in multiple clinical trials with promising results. When compared to HOPE for other organs, cardiac protocols involve red blood cell (RBC) supplementation, despite absence of comparative evidence for its benefits. In this perspective paper, we discuss the pros and cons of the addition of RBC's during cardiac HOPE. Although the current clinical results with RBC supplementation during HOPE seem promising, potential downsides of RBC supplementation cannot be ruled out. The impact of supplemented RBC's during cardiac HOPE requires further investigation to improve HOPE protocols, in order to optimize heart preservation using this promising technology.
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Affiliation(s)
- Mats T Vervoorn
- Department of Cardiothoracic Surgery. University Medical Center Utrecht. Utrecht, the Netherlands
| | - Elisa M Ballan
- Department of Cardiothoracic Surgery. University Medical Center Utrecht. Utrecht, the Netherlands; Department of Cardiology, laboratory of Experimental Cardiology. University Medical Center Utrecht. Utrecht, the Netherlands; Netherlands Heart Institute. Utrecht, the Netherlands
| | | | - Veronique M F Meijborg
- Department of Cardiology, laboratory of Experimental Cardiology. University Medical Center Utrecht. Utrecht, the Netherlands
| | - Saskia C A de Jager
- Department of Cardiology, laboratory of Experimental Cardiology. University Medical Center Utrecht. Utrecht, the Netherlands
| | - Richard Van Wijk
- Department Central Diagnostic Laboratory. University Medical Center Utrecht. Utrecht, the Netherlands
| | - Niels P van der Kaaij
- Department of Cardiothoracic Surgery. University Medical Center Utrecht. Utrecht, the Netherlands.
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4
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Vandendriessche K, Rega F, Van De Bruaene A. Innovations in transplant techniques for complex anomalies. Curr Opin Organ Transplant 2024; 29:316-322. [PMID: 39120600 DOI: 10.1097/mot.0000000000001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PURPOSE OF REVIEW With advances in the field of congenital cardiac surgery and in the management of congenital heart defects in early life, the population of adult congenital heart disease (ACHD) patients is increasing. End-stage heart failure is currently the main cause of cardiovascular mortality and is expected to increase in the coming years. This review summarizes recent innovations in transplant techniques, with special attention to what is known in the population of ACHD recipients. RECENT FINDINGS The use of machine perfusion for heart preservation enables longer preservation times. Normothermic (organ care system - OCS) and hypothermic (hypothermic oxygenated perfusion - HOPE) machine perfusion will alleviate the time pressure associated with heart transplantation in the ACHD population, may allow for expansion of the geographical range in which donors can be matched and may improve graft quality. Donation after circulatory death (DCD) heart transplantation, either through direct procurement-machine perfusion (DP-MP) or thoraco-abdominal normothermic regional perfusion (TA-NRP) is a viable strategy to further expand the donor pool. SUMMARY The use of machine perfusion and DCD donors in ACHD is feasible and shows promise. Time pressure and shortage of donors is even more critical in ACHD than in other patient populations, making these innovations particularly relevant. Further clinical experience and research is needed to elucidate their impact.
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Affiliation(s)
- Katrien Vandendriessche
- Division of Cardiac Surgery, University Hospitals Leuven
- Department of Cardiovascular Sciences, KU Leuven
| | - Filip Rega
- Division of Cardiac Surgery, University Hospitals Leuven
- Department of Cardiovascular Sciences, KU Leuven
| | - Alexander Van De Bruaene
- Department of Cardiovascular Sciences, KU Leuven
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
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5
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Chilvers NJS, Jeyakanthan M, Butt T, Crossland D, Dark JH, Ferraresi F, Hasan A, Hebala M, Jungschleger J, Khawaja M, MacGowan G, Nassar M, Robson J, Warburton J, Kenny L. The long-awaited solution for pediatric DCD heart transplantation? Comment on Brouckaert et al. J Heart Lung Transplant 2024:S1053-2498(24)01863-1. [PMID: 39293552 DOI: 10.1016/j.healun.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 09/11/2024] [Indexed: 09/20/2024] Open
Affiliation(s)
- Nicholas J S Chilvers
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mylvaganam Jeyakanthan
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Tanveer Butt
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - David Crossland
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - John H Dark
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Federico Ferraresi
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Asif Hasan
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Muhammed Hebala
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jerome Jungschleger
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Muhammad Khawaja
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Guy MacGowan
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Mohamed Nassar
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; Congenital Heart Disease Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jason Robson
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - James Warburton
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Louise Kenny
- Paediatric Heart Unit, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; Congenital Heart Disease Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
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Niroomand A, Nita GE, Lindstedt S. Machine Perfusion and Bioengineering Strategies in Transplantation-Beyond the Emerging Concepts. Transpl Int 2024; 37:13215. [PMID: 39267617 PMCID: PMC11390383 DOI: 10.3389/ti.2024.13215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/19/2024] [Indexed: 09/15/2024]
Abstract
Solid organ transplantation has progressed rapidly over the decades from the first experimental procedures to its role in the modern era as an established treatment for end-stage organ disease. Solid organ transplantation including liver, kidney, pancreas, heart, and lung transplantation, is the definitive option for many patients, but despite the advances that have been made, there are still significant challenges in meeting the demand for viable donor grafts. Furthermore, post-operatively, the recipient faces several hurdles, including poor early outcomes like primary graft dysfunction and acute and chronic forms of graft rejection. In an effort to address these issues, innovations in organ engineering and treatment have been developed. This review covers efforts made to expand the donor pool including bioengineering techniques and the use of ex vivo graft perfusion. It also covers modifications and treatments that have been trialed, in addition to research efforts in both abdominal organs and thoracic organs. Overall, this article discusses recent innovations in machine perfusion and organ bioengineering with the aim of improving and increasing the quality of donor organs.
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Affiliation(s)
- Anna Niroomand
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund, Sweden
| | - George Emilian Nita
- Department of Transplantation Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Division of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Lindstedt
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
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7
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Rega F, Lebreton G, Para M, Michel S, Schramm R, Begot E, Vandendriessche K, Kamla C, Gerosa G, Berman M, Boeken U, Clark S, Ranasinghe A, Ius F, Forteza A, Pivodic A, Hennig F, Guenther S, Zuckermann A, Knosalla C, Dellgren G, Wallinder A. Hypothermic oxygenated perfusion of the donor heart in heart transplantation: the short-term outcome from a randomised, controlled, open-label, multicentre clinical trial. Lancet 2024; 404:670-682. [PMID: 39153817 DOI: 10.1016/s0140-6736(24)01078-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/03/2024] [Accepted: 05/21/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Static cold storage (SCS) remains the gold standard for preserving donor hearts before transplantation but is associated with ischaemia, anaerobic metabolism, and organ injuries, leading to patient morbidity and mortality. We aimed to evaluate whether continuous, hypothermic oxygenated machine perfusion (HOPE) of the donor heart is safe and superior compared with SCS. METHODS We performed a multinational, multicentre, randomised, controlled, open-label clinical trial with a superiority design at 15 transplant centres across eight European countries. Adult candidates for heart transplantation were eligible and randomly assigned in a 1:1 ratio. Donor inclusion criteria were age 18-70 years with no previous sternotomy and donation after brain death. In the treatment group, the preservation protocol involved the use of a portable machine perfusion system ensuring HOPE of the resting donor heart. The donor hearts in the control group underwent ischaemic SCS according to standard practices. The primary outcome was time to first event of a composite of either cardiac-related death, moderate or severe primary graft dysfunction (PGD) of the left ventricle, PGD of the right ventricle, acute cellular rejection at least grade 2R, or graft failure (with use of mechanical circulatory support or re-transplantation) within 30 days after transplantation. We included all patients who were randomly assigned, fulfilled inclusion and exclusion criteria, and received a transplant in the primary analysis and all patients who were randomly assigned and received a transplant in the safety analyses. This trial was registered with ClicalTrials.gov (NCT03991923) and is ongoing. FINDINGS A total of 229 patients were enrolled between Nov 25, 2020, and May 19, 2023. The primary analysis population included 204 patients who received a transplant. There were no patients who received a transplant lost to follow-up. All 100 donor hearts preserved with HOPE were transplantable after perfusion. The primary endpoint was registered in 19 (19%) of 101 patients in the HOPE group and 31 (30%) of 103 patients in the SCS group, corresponding to a risk reduction of 44% (hazard ratio 0·56; 95% CI 0·32-0·99; log-rank test p=0·059). PGD was the primary outcome event in 11 (11%) patients in the HOPE group and 29 (28%) in the SCS group (risk ratio 0·39; 95% CI 0·20-0·73). In the HOPE group, 63 (65%) patients had a reported serious adverse event (158 events) versus 87 (70%; 222 events) in the SCS group. Major adverse cardiac transplant events were reported in 18 (18%) and 33 (32%) patients in the HOPE and SCS group (risk ratio 0·56; 95% CI 0·34-0·92). INTERPRETATION Although there was not a significant difference in the primary endpoint, the 44% risk reduction associated with HOPE was suggested to be a clinically meaningful benefit. Post-transplant complications, measured as major adverse cardiac transplant events, were reduced. Analysis of secondary outcomes suggested that HOPE was beneficial in reducing primary graft dysfunction. HOPE in donor heart preservation addresses the existing challenges associated with graft preservation and the increasing complexity of donors and heart transplantation recipients. Future investigation will help to further elucidate the benefit of HOPE. FUNDING XVIVO Perfusion.
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Affiliation(s)
- Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Guillaume Lebreton
- Cardiac Surgery Department, Pitié-Salpétrière Hospital, APHP, Sorbonne University, Paris, France
| | - Marylou Para
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, Université Paris Cité, Paris, France
| | - Sebastian Michel
- Clinic of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany; Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Emmanuelle Begot
- Cardiac Surgery Department, Pitié-Salpétrière Hospital, APHP, Sorbonne University, Paris, France
| | | | - Christine Kamla
- Clinic of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany; Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marius Berman
- Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - Steven Clark
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Aaron Ranasinghe
- Cardiac Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alberta Forteza
- Department of Cardiac Surgery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | | | - Felix Hennig
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Center for Cardiovascular Research, Berlin, Germany
| | - Sabina Guenther
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Center for Cardiovascular Research, Berlin, Germany
| | - Göran Dellgren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Zhang IW, Lurje I, Lurje G, Knosalla C, Schoenrath F, Tacke F, Engelmann C. Combined Organ Transplantation in Patients with Advanced Liver Disease. Semin Liver Dis 2024; 44:369-382. [PMID: 39053507 PMCID: PMC11449526 DOI: 10.1055/s-0044-1788674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Transplantation of the liver in combination with other organs is an increasingly performed procedure. Over the years, continuous improvement in survival could be realized through careful patient selection and refined organ preservation techniques, in spite of the challenges posed by aging recipients and donors, as well as the increased use of steatotic liver grafts. Herein, we revisit the epidemiology, allocation policies in different transplant zones, indications, and outcomes with regard to simultaneous organ transplants involving the liver, that is combined heart-liver, liver-lung, liver-kidney, and multivisceral transplantation. We address challenges surrounding combined organ transplantation such as equity, utility, and logistics of dual organ implantation, but also advantages that come along with combined transplantation, thereby focusing on molecular mechanisms underlying immunoprotection provided by the liver to the other allografts. In addition, the current standing and knowledge of machine perfusion in combined organ transplantation, mostly based on center experience, will be reviewed. Notwithstanding all the technical advances, shortage of organs, and the lack of universal eligibility criteria for certain multi-organ combinations are hurdles that need to be tackled in the future.
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Affiliation(s)
- Ingrid Wei Zhang
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin, Berlin, Germany
- European Foundation for the Study of Chronic Liver Failure (EF CLIF) and Grifols Chair, Barcelona, Spain
| | - Isabella Lurje
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Lurje
- Department of Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Cornelius Engelmann
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin, Berlin, Germany
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9
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Leon M. Revolutionizing Donor Heart Procurement: Innovations and Future Directions for Enhanced Transplantation Outcomes. J Cardiovasc Dev Dis 2024; 11:235. [PMID: 39195143 DOI: 10.3390/jcdd11080235] [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: 07/03/2024] [Revised: 07/19/2024] [Accepted: 07/25/2024] [Indexed: 08/29/2024] Open
Abstract
Heart failure persists as a critical public health challenge, with heart transplantation esteemed as the optimal treatment for patients with end-stage heart failure. However, the limited availability of donor hearts presents a major obstacle to meeting patient needs. In recent years, the most groundbreaking progress in heart transplantation has been in donor heart procurement, significantly expanding the donor pool and enhancing clinical outcomes. This review comprehensively examines these advancements, including the resurgence of heart donation after circulatory death and innovative recovery and evaluation technologies such as normothermic machine perfusion and thoraco-abdominal normothermic regional perfusion. Additionally, novel preservation methods, including controlled hypothermic preservation and hypothermic oxygenated perfusion, are evaluated. The review also explores the use of extended-criteria donors, post-cardiopulmonary resuscitation donors, and high-risk donors, all contributing to increased donor availability without compromising outcomes. Future directions, such as xenotransplantation, biomarkers, and artificial intelligence in donor heart evaluation and procurement, are discussed. These innovations promise to address current limitations and optimize donor heart utilization, ultimately enhancing transplantation success. By identifying recent advancements and proposing future research directions, this review aims to provide insights into advancing heart transplantation and improving patient outcomes.
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Affiliation(s)
- Marc Leon
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Falk CVRB, Stanford, CA 94305, USA
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10
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Zhu MZ, Marasco SF, Evans RG, Kaye DM, McGiffin DC. Acute Kidney Injury after Heart Transplantation: Risk Stratification is Good; Risk Modification is Better-But can we do it? Transplant Direct 2024; 10:e1635. [PMID: 38769977 PMCID: PMC11104722 DOI: 10.1097/txd.0000000000001635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Michael Z.L. Zhu
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, VIC, Australia
| | - Silvana F. Marasco
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Roger G. Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, VIC, Australia
- Preclinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - David M. Kaye
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - David C. McGiffin
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
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11
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Sicim H, Noly PE, Naik S, Sood V, Ohye RG, Haft JW, Aaronson KD, Pagani FD, Si MS, Tang PC. Determinants of survival following heart transplantation in adults with congenital heart disease. J Cardiothorac Surg 2024; 19:83. [PMID: 38336724 PMCID: PMC10858543 DOI: 10.1186/s13019-024-02509-0] [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: 09/21/2023] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Adult patients surviving with congenital heart disease (ACHD) is growing. We examine the factors associated with heart transplant outcomes in this challenging population with complex anatomy requiring redo-surgeries. METHODS We reviewed the United Network for Organ Sharing-Standard Transplant Analysis and Research database and analyzed 35,952 heart transplants from January 1st, 2000, to September 30th, 2018. We compared transplant characteristics for ischemic cardiomyopathy (ICM) (n = 14,236), nonischemic cardiomyopathy (NICM) (n = 20,676), and ACHD (n = 1040). Mean follow-up was 6.20 ± 4.84 years. Kaplan-Meier survival curves and Cox-proportional hazards analysis were used to analyze survival data. RESULTS Multivariable analysis confirmed that ACHD was associated greater in-hospital death compared to ICM (HR = 0.54, P < 0.001) and NICM (HR = 0.46, P < 0.001). Notable factors associated with increased mortality were history of cerebrovascular disease (HR = 1.11, P = 0.026), prior history of malignancy (HR = 1.12, P = 0.006), pre-transplant biventricular support (HR = 1.12, P = 0.069), postoperative stroke (HR = 1.47, P < 0.001) and postoperative dialysis (HR = 1.71, P < 0.001). ACHD transplants had a longer donor heart ischemic time (P < 0.001) and trend towards more deaths from primary graft dysfunction (P = 0.07). In-hospital deaths were more likely with ACHD and use of mechanical support such as use of right ventricular assist device (HR = 2.20, P = 0.049), biventricular support (HR = 1.62, P < 0.001) and extracorporeal membrane oxygenation (HR = 2.36, P < 0.001). Conditional survival after censoring hospital deaths was significantly higher in ACHD (P < 0.001). CONCLUSION Heart transplant in ACHD is associated with a higher post-operative mortality given anatomical complexity but a better long-term conditional survival. Normothermic donor heart perfusion may improve outcomes in the ACHD population by reducing the impact of longer ischemic times.
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Affiliation(s)
- Hüseyin Sicim
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Suyash Naik
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA
| | - Vikram Sood
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA
| | - Richard G Ohye
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA
| | - Jonathan W Haft
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA
| | - Keith D Aaronson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA
| | - Ming-Sing Si
- Department of Surgery, Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Paul C Tang
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA.
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
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Hoetzenecker K, Benazzo A, Schwarz S, Keshavjee S, Cypel M. The Advent of Semi-Elective Lung Transplantation-Prolonged Static Cold Storage at 10°C. Transpl Int 2024; 37:12310. [PMID: 38317690 PMCID: PMC10839059 DOI: 10.3389/ti.2024.12310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
Since the early days of clinical lung transplantation the preservation of donor organs has become a fairly standardized procedure and most centers do follow similar processes. This includes the use of low-potassium high dextran flush solutions and static cold storage (SCS) in a cooler filled with ice. Depending on the length of SCS, organs usually arrive at the recipient hospital at a temperature of 0°C-4°C. The question of the optimal storage temperature for donor lung preservation has been revisited as data from large animal experiments demonstrated that organs stored at 10°C experience less mitochondrial damage. Thus, prolonged cold ischemic times can be better tolerated at 10°C-even in pre-damaged organs. The clinical applicability of these findings was demonstrated in an international multi-center observational study including three high-volume lung transplant centers. Total clinical preservation times of up to 24 hrs have been successfully achieved in organs stored at 10°C without hampering primary organ function and short-term outcomes. Currently, a randomized-controlled trial (RCT) is recruiting patients with the aim to compare standard SCS on ice with prolonged SCS protocol at 10°C. If, as anticipated, this RCT confirms data from previous studies, lung transplantation could indeed become a semi-elective procedure.
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Affiliation(s)
- K. Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - A. Benazzo
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - S. Schwarz
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - S. Keshavjee
- Toronto Lung Transplant Program, Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - M. Cypel
- Toronto Lung Transplant Program, Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
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