Ex-situ oxygenated hypothermic machine perfusion in donation after circulatory death heart transplantation following either direct procurement or in-situ normothermic regional perfusion

被引:27
作者
Moeslund, Niels [1 ,2 ,4 ,6 ]
Ertugrul, Imran A. [3 ]
Hu, Michiel A. [3 ]
Dalsgaard, Frederik Flyvholm [1 ,2 ]
Ilkjaer, Lars Bo [4 ]
Ryhammer, Pia [5 ]
Pedersen, Michael [2 ]
Erasmus, Michiel E. [3 ]
Eiskjaer, Hans [1 ]
机构
[1] Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark
[2] Aarhus Univ, Dept Clin Med, Comparat Med Lab, Aarhus, Denmark
[3] Univ Med Ctr Groningen, Dept Cardiothorac Surg, Groningen, Netherlands
[4] Aarhus Univ Hosp, Dept Cardiothorac Surg, Aarhus, Denmark
[5] Reg Hosp Silkeborg, Dept Anesthesiol, Silkeborg, Denmark
[6] Aarhus Univ, Cardiol Res Dept Clin Med, Palle Juul Jensens Blvd 99, DK-8000 Aarhus N, Denmark
关键词
donation after circulatory death; Normothermic regional perfusion; Direct procurement; and perfusion; Hypothermic machine perfusion; heart transplantation; VIVO PERFUSION; DONOR HEARTS; PRESERVATION; INJURY; SEVOFLURANE; MECHANISMS; EXPERIENCE; ISCHEMIA;
D O I
10.1016/j.healun.2023.01.014
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Heart transplantation in donation after circulatory death (DCD) relies on warm perfu-sion using either in situ normothermic regional perfusion (NRP) or ex situ normothermic machine perfusion. In this study, we explore an alternative: oxygenated hypothermic machine perfusion (HMP) using a novel clinically applicable perfusion system, which is compared to NRP with static cold storage (SCS). METHODS: In a porcine model, a DCD setting was simulated, followed by either (1) NRP and SCS (2) NRP and HMP with the XVIVO Heart preservation system or (3) direct procurement (DPP) and HMP. After preservation, heart transplantation (HTX) was performed. After weaning from cardiopulmonary bypass (CPB), biventricular function was assessed by admittance and Swan-Ganz catheters. RESULTS: Only transplanted hearts in the HMP groups showed significantly increased biventricular contractility (end-systole elastance) 2 hour post-CPB (left ventricle absolute change: NRP HMP: +1.8 +/- 0.56, p = 0.047, DPP HMP: +1.5 +/- 0.43, p = 0.045 and NRP SCS: +0.97 +/- 0.47 mmHg/ml, p = 0.21; right ventricle absolute change: NRP HMP: +0.50 +/- 0.12, p = 0.025, DPP HMP: +0.82 +/- 0.23, p = 0.039 and NRP SCS: +0.28 +/- 0.26, p = 0.52) while receiving significantly less dobutamine to maintain a cardiac output >4l/min compared to SCS. Diastolic function was preserved in all groups. Post-HTX, both HMP groups showed significantly less increments in plasma troponin T compared to SCS. CONCLUSION: In DCD HTX, increased biventricular contractility post-HTX was only observed in hearts preserved with HMP. In addition, the need for inotropic support and signs of myocardial damage were lower in the HMP groups. DCD HTX can be successfully performed using DPP followed by preservation with HMP in a preclinical setting. J Heart Lung Transplant 2023;42:730-740 (c) 2023 The Author(s). Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
引用
收藏
页码:730 / 740
页数:11
相关论文
共 42 条
[1]   Hearts From DCD Donors Display Acceptable Biventricular Function After Heart Transplantation in Pigs [J].
Ali, A. A. ;
White, P. ;
Xiang, B. ;
Lin, H-Y. ;
Tsui, S. S. ;
Ashley, E. ;
Lee, T. W. ;
Klein, J. R. H. ;
Kumar, K. ;
Arora, R. C. ;
Large, S. R. ;
Tian, G. ;
Freed, D. H. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2011, 11 (08) :1621-1632
[2]   Heart Donation From Donors After Controlled Circulatory Death [J].
Anguela-Calvet, Laura ;
Moreno-Gonzalez, Gabriel ;
Sbraga, Fabrizio ;
Gonzalez-Costello, Jose ;
Tsui, Steven ;
Oliver-Juan, Eva .
TRANSPLANTATION, 2021, 105 (07) :1482-1491
[3]   Ex-vivo perfusion of donor hearts for human heart transplantation (PROCEED II): a prospective, open-label, multicentre, randomised non-inferiority trial [J].
Ardehali, Abbas ;
Esmailian, Fardad ;
Deng, Mario ;
Soltesz, Edward ;
Hsich, Eileen ;
Naka, Yoshifumi ;
Mancini, Donna ;
Camacho, Margarita ;
Zucker, Mark ;
Leprince, Pascal ;
Padera, Robert ;
Kobashigawa, Jon .
LANCET, 2015, 385 (9987) :2577-2584
[4]   Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass [J].
Asimakopoulos, G ;
Smith, PLC ;
Ratnatunga, CP ;
Taylor, KM .
ANNALS OF THORACIC SURGERY, 1999, 68 (03) :1107-1115
[5]  
Bianco RW, 2009, HANDBOOK OF CARDIAC ANATOMY, PHYSIOLOGY, AND DEVICES, SECOND EDITION, P393, DOI 10.1007/978-1-60327-372-5_25
[6]   Extended hypothermic oxygenated machine perfusion enables ex situ preservation of porcine livers for up to 24 hours [J].
Bruggenwirth, Isabel M. A. ;
van Leeuwen, Otto B. ;
de Vries, Yvonne ;
Bodewes, Silke B. ;
Adelmeijer, Jelle ;
Wiersema-Buist, Janneke ;
Lisman, Ton ;
Martins, Paulo N. ;
de Meijer, Vincent E. ;
Porte, Robert J. .
JHEP REPORTS, 2020, 2 (02)
[7]   Sevoflurane anesthetic preconditioning protects the lung endothelial glycocalyx from ischemia reperfusion injury in an experimental lung autotransplant model [J].
Casanova, Javier ;
Simon, Carlos ;
Vara, Elena ;
Sanchez, Guillermo ;
Rancan, Lisa ;
Abubakra, Selma ;
Calvo, Alberto ;
Jose Gonzalez, Francisco ;
Garutti, Ignacio .
JOURNAL OF ANESTHESIA, 2016, 30 (05) :755-762
[8]   Lactate during ex-situ heart perfusion does not predict the requirement for mechanical circulatory support following donation after circulatory death (DCD) heart transplants [J].
Cernic, Sendi ;
Page, Aravinda ;
Messer, Simon ;
Bhagra, Sai ;
Pettit, Stephen ;
Dawson, Sarah N. ;
Mckie, Mikel Alexander ;
Osman, Mohamed ;
Nachum, Eyal ;
White, Daniel ;
Ali, Jason ;
Fingelton, Lorraine ;
Howlett, Thomas ;
Tsui, Steven ;
Baxter, Jen ;
Falter, Florian ;
Jenkins, David P. ;
Kaul, Pradeep ;
Berman, Marius ;
Catarino, Pedro ;
Large, Stephen R. .
JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2022, 41 (09) :1294-1302
[9]   Outcomes of Donation After Circulatory Death Heart Transplantation in Australia [J].
Chew, Hong Chee ;
Iyer, Arjun ;
Connellan, Mark ;
Scheuer, Sarah ;
Villanueva, Jeanette ;
Gao, Ling ;
Hicks, Mark ;
Harkness, Michelle ;
Soto, Claudio ;
Dinale, Andrew ;
Nair, Priya ;
Watson, Alasdair ;
Granger, Emily ;
Jansz, Paul ;
Muthiah, Kavitha ;
Jabbour, Andrew ;
Kotlyar, Eugene ;
Keogh, Anne ;
Hayward, Chris ;
Graham, Robert ;
Spratt, Phillip ;
Macdonald, Peter ;
Dhital, Kumud .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2019, 73 (12) :1447-1459
[10]   A state-of-the-art review of the current role of cardioprotective techniques in cardiac transplantation [J].
Cullen, Paul P. ;
Tsui, Steven S. ;
Caplice, Noel M. ;
Hinchion, John A. .
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, 2021, 32 (05) :683-694