Recovery of donor hearts after circulatory death with normothermic extracorporeal machine perfusion
| Autor: | Asya Makhro, Barbara Rosser, Herman Tolboom, Anna Bogdanova, Markus J. Wilhelm, Volkmar Falk |
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| Přispěvatelé: | University of Zurich, Tolboom, Herman |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Ischemia Transplants Cold storage 610 Medicine & health Myocardial Reperfusion Models Biological 2705 Cardiology and Cardiovascular Medicine Contractility Reperfusion therapy Heart Rate Internal medicine Animals Medicine 10217 Clinic for Visceral and Transplantation Surgery Machine perfusion biology business.industry Heart Organ Preservation General Medicine 10081 Institute of Veterinary Physiology medicine.disease 10020 Clinic for Cardiac Surgery 2746 Surgery Rats Transplantation Oxidative Stress 2740 Pulmonary and Respiratory Medicine 10076 Center for Integrative Human Physiology Tissue and Organ Harvesting biology.protein Cardiology 570 Life sciences Heart Transplantation Surgery Creatine kinase Cardiology and Cardiovascular Medicine business Perfusion |
| Popis: | OBJECTIVES A severe donor organ shortage leads to the death of a substantial number of patients who are listed for transplantation. The use of hearts from donors after circulatory death could significantly expand the donor organ pool, but due to concerns about their viability, these are currently not used for transplantation. We propose short-term ex vivo normothermic machine perfusion (MP) to improve the viability of these ischaemic donor hearts. METHODS Hearts from male Lewis rats were subjected to 25 min of global in situ warm ischaemia (WI) (37°C), explanted, reconditioned for 60 min with normothermic (37°C) MP with diluted autologous blood and then stored for 4 h at 0-4°C in Custodiol cold preservation solution. Fresh and ischaemic hearts stored for 4 h in Custodiol were used as controls. Graft function was assessed in a blood-perfused Langendorff circuit. RESULTS During reconditioning, both the electrical activity and contractility of the ischaemic hearts recovered rapidly. Throughout the Langendorff reperfusion, the reconditioned ischaemic hearts had a higher average heart rate and better contractility compared with untreated ischaemic controls. Moreover, the reconditioned ischaemic hearts had higher tissue adenosine triphosphate levels and a trend towards improved tissue redox state. Perfusate levels of troponin T, creatine kinase and lactate dehydrogenase were not significantly lower than those of untreated ischaemic controls. The micro- and macroscopic appearance of the reconditioned ischaemic hearts were improved compared with ischaemic controls, but in both groups myocardial damage and oedema were evident. CONCLUSIONS Our results indicate that functional recovery from global WI is possible during short-term ex vivo reperfusion, allowing subsequent cold storage without compromising organ viability. We expect that once refined and validated, this approach may enable safe transplantation of hearts obtained from donation after circulatory death |
| Databáze: | OpenAIRE |
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