Myocardial viability twenty-four hours after orthotopic heart transplantation from non-heart-beating donors

Abstract

Recovery of donor hearts from non-heart-beating donors is comparable with recovery of organs harvested from heart-beating donors if the above-mentioned preservation technique is used. These results could encourage the use of marginal donor hearts and help to expand the limited donor pool.

Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience

“…Furthermore, there is growing evidence that even heart transplantation could be performed using NHBD, as isolated instances of clinical transplantations have been reported yet [153]. Experimentally, encouraging results are reported recently with pig heart transplantation from NHBD after 30 min of normothermic ischemia [154][155][156]. Although this experimentally successful concept might not be transferable to standard clinical practice in the near future, it could be anticipated that at least donor hearts with prolonged ischemia >4 h and/or hearts from donors with a variable amount of cardiac arrest prior to organ harvest could be an additional source of donor grafts.…”

“…At least, the sophisticated experimental concepts of recovery of donor hearts from NHBD, i.e. mode of controlled reperfusion, etc., can successfully be used in very marginal heart donors whose grafts are currently rejected even by high-volume transplant units with extended 'marginal donor' protocols because of a significantly increased risk of primary graft failure [156].…”

The Suppression of Proinflammatory Cytokines Improves Heart Function From Non-Heart-Beating Donors Following Transplantation in a Canine Model

“…In those NHBD experiments, the hearts were damaged by a combination of hypoxia and warm ischemia of at least 15-30 minutes in situ. [19][20][21] In addition, there is a fear that the heart will sustain I/R injury after prolonged ischemia during peri-mortem arrest and the waiting period that follows. 13) Useful preservation methods to reduce I/R injury are necessary for the clinical use of NHBDs in heart transplantation.…”

Anesthetic considerations in organ procurement surgery: a narrative review

“…Because ventilation with oxygenation may risk restoration of cerebral oxygen delivery, mechanical ventilation should not be initiated until cerebral circulation has been isolated via a crossclamp across the aortic arch vessels. 44,74 Once mechanical ventilation is re-initiated, tidal volumes should be 6-8 mgÁkg -1 with 8-10 cm H 2 O PEEP in order to decrease the risk of acute lung injury. 6 Liver transplantation Although favourable outcomes have been achieved with the use of DCD liver grafts, 75 there has been a higher rate of biliary complications associated with these organs, and thus, they are considered to represent a higher risk option for the recipient.…”

“…45 Use of cardioplegia may offer some promise of a successful heart transplant in the setting of DCD, but further research is needed. 74 …”