Heart transplant advances: Ex vivo organ-preservation systems

Bryner, Benjamin S.; Schroder, Jacob N.; Milano, Carmelo A.

doi:10.1016/j.xjon.2021.04.020

Cited by 10 publications

(4 citation statements)

References 20 publications

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“…This concept was tested in the EXPAND trial (International Trial to Evaluate the Safety and Effectiveness of The Portable Organ Care System Heart For Preserving and Assessing Expanded Criteria Donor Hearts for Transplantation), which analyzed high-risk transplants with anticipated prolonged ischemic times (>4 h) or marginal donor heart features (left ventricular hypertrophy, an ejection fraction of 40-50%, donor downtime >20 min, and donor age >55 years). The short-term results showed excellent short-term outcomes in 75 patients transplanted from a total of 93 hearts recovered and perfused on the OCS [34].…”

Section: Clinical Studies With the Organ Care Systemmentioning

confidence: 94%

“…Furthermore, MP allows for donor heart assessment before implantation, and this may facilitate the use of marginal donors. More importantly, MP may become a platform for cardioprotective approaches, enabling the repair and reconditioning of donor hearts [34]. In heart transplantation, two methods of ex vivo perfusion have been reported: hypothermic (4-8 • C) and near normothermic (>32.8 • C).…”

Section: Ex Vivo Machine Perfusion As a Novel Strategy To Preserve Th...mentioning

confidence: 99%

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Donor Heart Preservation: Current Knowledge and the New Era of Machine Perfusion

Kounatidis,

Brozou,

Anagnostopoulos

et al. 2023

IJMS

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Heart transplantation remains the conventional treatment in end-stage heart failure, with static cold storage (SCS) being the standard technique used for donor preservation. Nevertheless, prolonged cold ischemic storage is associated with the increased risk of early graft dysfunction attributed to residual ischemia, reperfusion, and rewarming damage. In addition, the demand for the use of marginal grafts requires the development of new methods for organ preservation and repair. In this review, we focus on current knowledge and novel methods of donor preservation in heart transplantation. Hypothermic or normothermic machine perfusion may be a promising novel method of donor preservation based on the administration of cardioprotective agents. Machine perfusion seems to be comparable to cold cardioplegia regarding donor preservation and allows potential repair treatments to be employed and the assessment of graft function before implantation. It is also a promising platform for using marginal organs and increasing donor pool. New pharmacological cardiac repair treatments, as well as cardioprotective interventions have emerged and could allow for the optimization of this modality, making it more practical and cost-effective for the real world of transplantation. Recently, the use of triiodothyronine during normothermic perfusion has shown a favorable profile on cardiac function and microvascular dysfunction, likely by suppressing pro-apoptotic signaling and increasing the expression of cardioprotective molecules.

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Section: Clinical Studies With the Organ Care Systemmentioning

confidence: 94%

Section: Ex Vivo Machine Perfusion As a Novel Strategy To Preserve Th...mentioning

confidence: 99%

Donor Heart Preservation: Current Knowledge and the New Era of Machine Perfusion

Kounatidis,

Brozou,

Anagnostopoulos

et al. 2023

IJMS

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“…The study demonstrated short-term survival rates were 94.7 and 88% at 30 days and 6 months respectively. The incidence of primary graft dysfunction at 24 hours postoperatively was 10.7% [2,20,53,54].…”

Section: Author Detailsmentioning

confidence: 95%

Heart Preservation Techniques for Transplantation

Ruaengsri,

M. Bethencourt,

Koyano

et al. 2024

Cardiology and Cardiovascular Medicine

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Heart transplant remains the gold standard of end-stage heart failure treatment. The number of heart transplants performed each year has increased and the number of recipient candidates has been increasing even more. As a result, recipients are now matched with donors over longer distances with increasing organ ischemic time. Organ preservation strategies have been evolving to minimize ischemia reperfusion injury following longer ischemic times. This chapter will include updated organ donation and preservation techniques for heart transplant including organ donation after brain death (DBD) and donation after circulatory death (DCD). The expansion of cardiac donation after circulatory death (DCD) and new techniques for heart preservation may increase the use of hearts from extended criteria donors and thus expand the heart donor pool.

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“…Preparation and management of heart on Organ Care System The heart is prepared for OCS on the back table [73]: (1) Insertion of aortic cannula; an appropriately sized aortic tip cannula is attached to the ascending aorta using a cable tie. This serves as the point of suspension for the heart on the device and provides the route for the delivery of perfusate.…”

Section: Operative Techniquementioning

confidence: 99%

Ex vivo lung perfusion and the Organ Care System: a review

Attawar,

et al. 2024

Clin Transplant Res

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With the increasing prevalence of heart failure and end-stage lung disease, there is a sustained interest in expanding the donor pool to alleviate the thoracic organ shortage crisis. Efforts to extend the standard donor criteria and to include donation after circulatory death have been made to increase the availability of suitable organs. Studies have demonstrated that outcomes with extended-criteria donors are comparable to those with standard-criteria donors. Another promising approach to augment the donor pool is the improvement of organ preservation techniques. Both ex vivo lung perfusion (EVLP) for the lungs and the Organ Care System (OCS, TransMedics) for the heart have shown encouraging results in preserving organs and extending ischemia time through the application of normothermic regional perfusion. EVLP has been effective in improving marginal or borderline lungs by preserving and reconditioning them. The use of OCS is associated with excellent short-term outcomes for cardiac allografts and has improved utilization rates of hearts from extended-criteria donors. While both EVLP and OCS have successfully transitioned from research to clinical practice, the costs associated with commercially available systems and consumables must be considered. The ex vivo perfusion platform, which includes both EVLP and OCS, holds the potential for diverse and innovative therapies, thereby transforming the landscape of thoracic organ transplantation.

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Heart transplant advances: Ex vivo organ-preservation systems

Cited by 10 publications

References 20 publications

Donor Heart Preservation: Current Knowledge and the New Era of Machine Perfusion

Donor Heart Preservation: Current Knowledge and the New Era of Machine Perfusion

Heart Preservation Techniques for Transplantation

Ex vivo lung perfusion and the Organ Care System: a review

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