Hemodynamic and perioperative management in two different preclinical pig‐to‐baboon cardiac xenotransplantation models

Abstract

Intensive intra- and postoperative monitoring and care is required in both transplantation techniques as a requirement for successful weaning from CPB and respirator. After htHTx, the animals needed less catecholamines and were hemodynamically more stable. Even though pulmonary function was often impaired after htHTx, weaning from the respirator and extubation was more successful in this group.

Hemodynamic evaluation of anesthetized baboons and piglets by transpulmonary thermodilution: Normal values and interspecies differences with respect to xenotransplantation

“…6,7 In xenotransplantation, TPTD has been used to assess CO during pig-to-primate kidney 8 and heart transplantation. [9][10][11] As for human allotransplantation, comprehensive hemodynamic monitoring and careful therapeutic management are key to a favorable outcome after cardiac xenotransplantation. However, little is known about the normal values in baboons and piglets of the sizes used for these experiments.…”

Consideration of appropriate clinical applications for cardiac xenotransplantation

“…[86][87][88][89] Expression of hCD39, which has known antiinflammatory and immunomodulatory properties, has been demonstrated to significantly reduce myocardial ischemia-reperfusion injury in transgenic swine, suggesting that high levels of hCD39 expression may be essential. 91,92 Further optimization of these concepts in perioperative management, and the use of additional cardioprotective maneuvers, such as remote ischemic preconditioning, metabolic support, and pharmacologic administration, may also be required to minimize PCXD. 91,92 Further optimization of these concepts in perioperative management, and the use of additional cardioprotective maneuvers, such as remote ischemic preconditioning, metabolic support, and pharmacologic administration, may also be required to minimize PCXD.…”

“…90 Improvements in organ preservation and intensive care practices, as well as diminishing early xenospecific inflammatory responses, have shown to be efficacious in reducing PCXD. 91,92 Further optimization of these concepts in perioperative management, and the use of additional cardioprotective maneuvers, such as remote ischemic preconditioning, metabolic support, and pharmacologic administration, may also be required to minimize PCXD. [93][94][95][96]…”

Porcine to Human Heart Transplantation: Is Clinical Application Now Appropriate?

“…Intrathoracic heterotopic cardiac transplantation, where both the donor and recipient hearts contribute to the circulation, was successfully used in early allotransplantation when techniques for donor organ preservation were being optimized. Preclinical intrathoracic heterotopic cardiac xenotransplantation studies, although complex, potentially offer a unique opportunity to study the aetiology and recovery from PCXD [ 102 , 103 ]. Genetic engineering approaches may also have the potential to mitigate PCXD, for example, by providing high levels of CD39 expression [ 75 ] or reducing sodium hydrogen ion exchange activity [ 104 ].…”