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Eur J Cardiothorac Surg. 2016 May;49(5):1348-53. doi: 10.1093/ejcts/ezv409. Epub 2015 Nov 24.

Hypothermic continuous machine perfusion enables preservation of energy charge and functional recovery of heart grafts in an ex vivo model of donation following circulatory death.

Author information

1
Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium olivier.vancaenegem@uclouvain.be.
2
Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium Division of Cardiology, Cliniques universitaires Saint-Luc, Brussels, Belgium.
3
Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
4
Organ Recovery Systems©, Zaventem, Belgium.
5
Division of Cardiac Surgery, Cliniques universitaires Saint Luc, Brussels, Belgium.
6
Division of Cardiac Surgery, Cliniques universitaires Saint Luc, Brussels, Belgium Pôle de chirurgie expérimentale et transplantation, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
7
Pôle de chirurgie expérimentale et transplantation, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
8
Pôle de biochimie et recherche métabolique, Institut de Duve, Université catholique de Louvain, Brussels, Belgium.
9
Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium.
10
Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Division of Cardiology, Cliniques universitaires Saint-Luc, Brussels, Belgium.

Abstract

OBJECTIVES:

Cardiac transplantation using hearts from donors after circulatory death (DCD) is critically limited by the unavoidable warm ischaemia and its related unpredictable graft function. Inasmuch as hypothermic machine perfusion (MP) has been shown to improve heart preservation, we hypothesized that MP could enable the use of DCD hearts for transplantation.

METHODS:

We recovered 16 pig hearts following anoxia-induced cardiac arrest and cardioplegia. Grafts were randomly assigned to two different groups of 4-h preservation using either static cold storage (CS) or MP (Modified LifePort© System, Organ Recovery Systems©, Itasca, Il). After preservation, the grafts were reperfused ex vivo using the Langendorff method for 60 min. Energetic charge was quantified at baseline, post-preservation and post-reperfusion by measuring lactate and high-energy phosphate levels. Left ventricular contractility parameters were assessed both in vivo prior to ischaemia and ex vivo during reperfusion.

RESULTS:

Following preservation, the hearts that were preserved using CS exhibited higher lactate levels (57.1 ± 23.7 vs 21.4 ± 12.2 µmol/g; P < 0.001), increased adenosine monophosphate/adenosine triphosphate ratio (0.53 ± 0.25 vs 0.11 ± 0.11; P < 0.001) and lower phosphocreatine/creatine ratio (9.7 ± 5.3 vs 25.2 ± 11; P < 0.001) in comparison with the MP hearts. Coronary flow was similar in both groups during reperfusion (107 ± 9 vs 125 ± 9 ml/100 g/min heart; P = ns). Contractility decreased in the CS group, yet remained well preserved in the MP group.

CONCLUSION:

MP preservation of DCD hearts results in improved preservation of the energy and improved functional recovery of heart grafts compared with CS.

KEYWORDS:

Donation after circulatory death; Heart transplantation; Machine perfusion

PMID:
26604296
DOI:
10.1093/ejcts/ezv409
[Indexed for MEDLINE]

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