作者
Louise E. See Hoe,Gianluigi Li Bassi,Karin Wildi,Margaret Passmore,Mahé Bouquet,K. Sato,Silver Heinsar,Carmen Ainola,Nicole Bartnikowski,Emily Wilson,Kieran Hyslop,K. Skeggs,Nchafatso G. Obonyo,Tristan Shuker,L Bradbury,Chiara Palmieri,Sanne Engkilde-Pedersen,Charles McDonald,Sebastiano Maria Colombo,M. Wells,Janice D. Reid,H. O'Neill,Samantha Livingstone,Gabriella Abbate,Andrew B. Haymet,Jae Seung Jung,Noriko Sato,L. James,Ting He,Nicole White,Meredith A. Redd,Jonathan Millar,Maximilian Malfertheiner,Peter Molenaar,D. Platts,Jonathan Chan,Jacky Y. Suen,David C. McGiffin,John F. Fraser
摘要
Background
The global shortage of donor hearts available for transplantation is a major problem for the treatment of end-stage heart failure. The ischemic time for donor hearts using traditional preservation by standard static cold storage (SCS) is limited to approximately 4 hours, beyond which the risk for primary graft dysfunction (PGD) significantly increases. Hypothermic machine perfusion (HMP) of donor hearts has been proposed to safely extend ischemic time without increasing the risk of PGD. Methods
Using our sheep model of 24 hours brain death (BD) followed by orthotopic heart transplantation (HTx), we examined post-transplant outcomes in recipients following donor heart preservation by HMP for 8 hours, compared to donor heart preservation for 2 hours by either SCS or HMP. Results
Following HTx, all HMP recipients (both 2 hours and 8 hours groups) survived to the end of the study (6 hours after transplantation and successful weaning from cardiopulmonary bypass), required less vasoactive support for hemodynamic stability, and exhibited superior metabolic, fluid status and inflammatory profiles compared to SCS recipients. Contractile function and cardiac damage (troponin I release and histological assessment) was comparable between groups. Conclusions
Overall, compared to current clinical SCS, recipient outcomes following transplantation are not adversely impacted by extending HMP to 8 hours. These results have important implications for clinical transplantation where longer ischemic times may be required (e.g., complex surgical cases, transport across long distances). Additionally, HMP may allow safe preservation of "marginal" donor hearts that are more susceptible to myocardial injury and facilitate increased utilization of these hearts for transplantation.