Donor heart ischemic time can be extended beyond 9 hours using hypothermic machine perfusion in sheep

See, L.E.; Li Bassi, G.; Wildi, K.; Passmore, M.R.; Bouquet, M.; Sato, K.; Heinsar, S.; Ainola, C.; Bartnikowski, N.; Wilson, E.S.; Hyslop, K.; Skeggs, K.; Obonyo, N.G.; Shuker, T.; Bradbury, L.; Palmieri, C.; Engkilde-Pedersen, S.; Mcdonald, C.; Colombo, S.M.; Wells, M.A.; Reid, J.D.; O'Neill, H.; Livingstone, S.; Abbate, G.; Haymet, A.; Jung, J.; Sato, N.; James, L.; Ting, H.; White, N.; Redd, M.A.; Millar, J.E.; Maximillian, M.; V,; Molenaar, P.; Platts, D.; Chan, J.; Suen, J.Y.; Mcgiffin, D.C.; Fraser, J.F.

doi:10.1016/J.HEALUN.2023.03.020

BACKGROUND: Theglobalshortageofdonorheartsavailablefortransplantationisamajorproblemforthetreatmentofend-stageheartfailure.Theischemictimefordonorheartsusingtraditionalpreserva-tionbystandardstaticcoldstorage(SCS)islimitedtoapproximately4hours,beyondwhichtheriskforprimarygraftdysfunction(PGD)significantlyincreases.Hypothermicmachineperfusion(HMP)ofdonorheartshasbeenproposedtosafelyextendischemictimewithoutincreasingtheriskofPGD.METHODS:Usingoursheepmodelof24hoursbraindeath(BD)followedbyorthotopichearttransplan-tation(HTx),weexaminedpost-transplantoutcomesinrecipientsfollowingdonorheartpreservationbyHMPfor8hours,comparedtodonorheartpreservationfor2hoursbyeitherSCSorHMP.RESULTS:FollowingHTx,allHMPrecipients(both2hoursand8hoursgroups)survivedtotheendofthestudy(6hoursaftertransplantationandsuccessfulweaningfromcardiopulmonarybypass),requiredlessvasoactivesupportforhemodynamicstability,andexhibitedsuperiormetabolic,fluidsta-tusandinflammatoryprofilescomparedtoSCSrecipients.Contractilefunctionandcardiacdamage(troponinIreleaseandhistologicalassessment)wascomparablebetweengroups.CONCLUSIONS:Overall,comparedtocurrentclinicalSCS,recipientoutcomesfollowingtransplanta-tionarenotadverselyimpactedbyextendingHMPto8hours.Theseresultshaveimportantimplica-tionsforclinicaltransplantationwherelongerischemictimesmayberequired(e.g.,complexsurgicalcases,transportacrosslongdistances).Additionally,HMPmayallowsafepreservationof“marginal”donorheartsthataremoresusceptibletomyocardialinjuryandfacilitateincreasedutilizationoftheseheartsfortransplantation.

Donor heart ischemic time can be extended beyond 9 hours using hypothermic machine perfusion in sheep / L.E. See, G. Li Bassi, K. Wildi, M.R. Passmore, M. Bouquet, K. Sato, S. Heinsar, C. Ainola, N. Bartnikowski, E.S. Wilson, K. Hyslop, K. Skeggs, N.G. Obonyo, T. Shuker, L. Bradbury, C. Palmieri, S. Engkilde-Pedersen, C. Mcdonald, S.M. Colombo, M.A. Wells, J.D. Reid, H. O'Neill, S. Livingstone, G. Abbate, A. Haymet, J. Jung, N. Sato, L. James, T. He, N. White, M.A. Redd, J.E. Millar, M. Malfertheiner, V, P. Molenaar, D. Platts, J. Chan, J.Y. Suen, D.C. Mcgiffin, J.F. Fraser. - In: THE JOURNAL OF HEART AND LUNG TRANSPLANTATION. - ISSN 1053-2498. - 42:8(2023 Aug), pp. 1015-1029. [10.1016/J.HEALUN.2023.03.020]

Donor heart ischemic time can be extended beyond 9 hours using hypothermic machine perfusion in sheep

See, Louise E.;G. Li Bassi^Secondo;Wildi, Karin;Passmore, Margaret R.;Bouquet, Mahe;Sato, Kei;Heinsar, Silver;Ainola, Carmen;Bartnikowski, Nicole;Wilson, Emily S.;Hyslop, Kieran;Skeggs, Kris;Obonyo, Nchafatso G.;Shuker, Tristan;Bradbury, Lucy;Palmieri, Chiara;Engkilde-Pedersen, Sanne;McDonald, Charles;S.M. Colombo;Wells, Matthew A.;Reid, Janice D.;O'Neill, Hollier;Livingstone, Samantha;Abbate, Gabriella;Haymet, Andrew;Jung, Jae-Seung;Sato, Noriko;James, Lynnette;He, Ting;White, Nicole;Redd, Meredith A.;Millar, Jonathan E.;Malfertheiner Maximillian;V;Molenaar, Peter;Platts, David;Chan, Jonathan;Suen, Jacky Y.;McGiffin, David C.;Fraser, John F.

2023

Abstract

BACKGROUND: Theglobalshortageofdonorheartsavailablefortransplantationisamajorproblemforthetreatmentofend-stageheartfailure.Theischemictimefordonorheartsusingtraditionalpreserva-tionbystandardstaticcoldstorage(SCS)islimitedtoapproximately4hours,beyondwhichtheriskforprimarygraftdysfunction(PGD)significantlyincreases.Hypothermicmachineperfusion(HMP)ofdonorheartshasbeenproposedtosafelyextendischemictimewithoutincreasingtheriskofPGD.METHODS:Usingoursheepmodelof24hoursbraindeath(BD)followedbyorthotopichearttransplan-tation(HTx),weexaminedpost-transplantoutcomesinrecipientsfollowingdonorheartpreservationbyHMPfor8hours,comparedtodonorheartpreservationfor2hoursbyeitherSCSorHMP.RESULTS:FollowingHTx,allHMPrecipients(both2hoursand8hoursgroups)survivedtotheendofthestudy(6hoursaftertransplantationandsuccessfulweaningfromcardiopulmonarybypass),requiredlessvasoactivesupportforhemodynamicstability,andexhibitedsuperiormetabolic,fluidsta-tusandinflammatoryprofilescomparedtoSCSrecipients.Contractilefunctionandcardiacdamage(troponinIreleaseandhistologicalassessment)wascomparablebetweengroups.CONCLUSIONS:Overall,comparedtocurrentclinicalSCS,recipientoutcomesfollowingtransplanta-tionarenotadverselyimpactedbyextendingHMPto8hours.Theseresultshaveimportantimplica-tionsforclinicaltransplantationwherelongerischemictimesmayberequired(e.g.,complexsurgicalcases,transportacrosslongdistances).Additionally,HMPmayallowsafepreservationof“marginal”donorheartsthataremoresusceptibletomyocardialinjuryandfacilitateincreasedutilizationoftheseheartsfortransplantation.

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	Parole chiave
	
				heart transplantation; hypothermic machine perfusion; organ preservation; static cold storage;
			
	Settori scientifico-disciplinari dell'articolo (validi dal 09/05/2024)
	
				Settore MEDS-23/A - Anestesiologia
			
	Data di pubblicazione
	
				ago-2023
			
	Rivista in ANCE
	
				THE JOURNAL OF HEART AND LUNG TRANSPLANTATION
			
	DOI
	
				https://dx.doi.org/10.1016/J.HEALUN.2023.03.020
			
	Tipologia
	
				Article (author)
			
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				01 - Articolo su periodico

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