Successful orthotopic pig heart transplantation from non-heart-beating donors

Use of Diffusion Tensor Imaging to Predict Myocardial Viability After Warm Global Ischemia: Possible Avenue for Use of Non-beating Donor Hearts

“…Classic histologic changes, such as contraction band necrosis, do not manifest for several hours after reperfusion, 20 and other studies using a continuous perfusion protocol found that routine tests for the assessment of creatine kinase MB could not reliably predict recovery after WI. 18,19 The assessment of histologic changes and troponin I release from WI ϩ CP hearts in the present study corroborates the limitations of these methods.…”

Myocardial and endothelial protection for heart transplantation in the new millenium: lessons learned and future directions

“…In contrast, controlled reperfusion with leukocytedepleted, substrate-and HOE-642-enriched blood cardioplegia in the same model resulted in markedly improved contractility, and the animals were weaned successfully from extracorporeal circulation. 12,13 Hemodynamic measurements 24 hours after HTx revealed no significant difference between the non-heart-beating donors and a control group transplanted from heart-beating donors. Post-mortem examination showed only minimal histologic damage to the myocardium.…”

“…24 Leukocyte filtration has been shown to be effective in treating endothelial injury after both acute coronary occlusion 26 and HTx. 12,13,27,28 In addition, prevention (rather than treatment) of endothelial stunning may be possible, because some investigators have found that delivery of the natural nitric oxide precursor, L-arginine, limits endothelial and myocyte damage, even without white blood cell depletion. 29 -31 The relation between myocyte and endothelial injury and stunning is underscored by reports that, in cardiac transplantation, myocardial protection may be important for both early graft failure and non-immunologic vascular failure of the transplanted heart, leading to allograft vascular disease.…”

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.…”