The role of ex-situ perfusion for thoracic organs DOI
Maximilian J. Roesel, Bettina Wiegmann, F. Ius

et al.

Current Opinion in Organ Transplantation, Journal Year: 2022, Volume and Issue: 27(5), P. 466 - 473

Published: Aug. 3, 2022

Purpose of review Ex-situ machine perfusion for both heart (HTx) and lung transplantation (LuTx) reduces ischemia–reperfusion injury (IRI), allows greater flexibility in geographical donor management, continuous monitoring, organ assessment extended evaluation, potential reconditioning marginal organs. In this review, we will delineate the impact perfusion, characterize novel opportunities, outline challenges lying ahead to improve further implementation. Recent findings Due success several randomized controlled trials (RCT), comparing cold storage HTx LuTx, implementation innovation continues. Indeed, it represents a promising interface organ-specific therapies targeting IRI, allo-immune responses, graft reconditioning. These mostly experimental efforts range from genetic approaches nanotechnology cellular therapies, involving mesenchymal stem cell application. Despite tremendous potential, prior clinical transition, more data is needed. Summary Collectively, constitutes vanguard thoracic research with extensive expanding pool, enhancing transplant outcomes as well developing therapy approaches.

Language: Английский

Heart Transplantation From DCD Donors in Australia: Lessons Learned From the First 74 Cases DOI Open Access
Yashutosh Joshi, S. Scheuer, H. Chew

et al.

Transplantation, Journal Year: 2022, Volume and Issue: 107(2), P. 361 - 371

Published: Aug. 31, 2022

Heart transplantation from donation after circulatory death (DCD) donors has the potential to substantially increase overall heart transplant activity. The aim of this report is review first 8 y our clinical program at St Vincent’s Hospital Sydney, describe how evolved and impact that changes retrieval protocols have had on posttransplant outcomes. Since 2014, we performed 74 DCD transplants utilizing a direct procurement protocol followed by normothermic machine perfusion. Changes resulted in higher rate fewer rejections hearts during Compared with previously reported early experience 23 transplants, observed significant reduction incidence severe primary graft dysfunction 35% (8/23) 8% (4/51) subsequent 51 recipients ( P < 0.01). only withdrawal time interval significantly associated was asystolic warm ischemic time: 15 (12–17) versus 13 (11–14) min 0.05). One- 5-y survival 94% 88%, comparable contemporary cohort brain recipients: 87 81% -value not significant). In conclusion, become major contributor activity accounting for almost 30% all last 2 y, similar

Language: Английский

Citations

53
Early Outcomes of Heart Transplantation Using Donation After Circulatory Death Donors in the United States DOI Open Access
Jennie H. Kwon, Alexander Ghannam, Khaled Shorbaji

et al.

Circulation Heart Failure, Journal Year: 2022, Volume and Issue: 15(12)

Published: Dec. 1, 2022

Limited donor availability and evolution in procurement techniques have renewed interest heart transplantation (HT) with donation after circulatory death (DCD). The aim of this study is to evaluate outcomes HT using DCD the United States.The Network for Organ Sharing registry was used identify adult recipients from 2019 2021. Recipients were stratified between brain death. Propensity-score matching performed. Cox proportional hazards independent predictors 1-year mortality. Kaplan-Meier analysis estimate survival.Of 7496 HTs, 229 7267 analyzed. frequency increased 0.2% all 6.4% 2021 (P<0.001), number centers performing 3 120 20 121 (P<0.001). donors more likely be younger, male, White. After propensity matching, survival 92.5% versus 90.3% (hazard ratio, 0.80 [95% CI, 0.44-1.43]; P=0.44). Among increasing recipient age waitlist time predicted mortality on univariable analysis.Rates States are increasing. This practice appears safe feasible as comparable Although represents early adopting centers, experience consistent existing international data encourages broader utilization practice.

Language: Английский

Citations

46
Normothermic Regional Perfusion is an Emerging Cost-Effective Alternative in Donation After Circulatory Death (DCD) in Heart Transplantation DOI Open Access

Emad Alamouti-fard,

Pankaj Garg, Ishaq J Wadiwala

et al.

Cureus, Journal Year: 2022, Volume and Issue: unknown

Published: June 29, 2022

In donation after circulatory death (DCD) organ transplantation, normothermic regional perfusion (NRP) restores oxygenated blood flow following cardiac arrest and reverses warm ischemia. Recently, NRP has also been used to help recover DCD hearts in addition the abdominal organs. While increased number of organs lungs pool, it not able increase heart transplants, despite fact that potential transplants by 15-30%. Thoracoabdominal makes transplantation feasible permits assessing function before an procurement without affecting preservation can be two ways for donor transplants: followed machine (NRP-MP) static cold storage (NRP-SCS). Normothermic is emerging technology, a cost-effective alternative (DCD), will pool donors transplantation.

Language: Английский

Citations

42
Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion DOI
Jordan Hoffman, Matthew G. Hartwig, Michael T. Cain

et al.

The Annals of Thoracic Surgery, Journal Year: 2024, Volume and Issue: 118(4), P. 778 - 791

Published: July 19, 2024

Language: Английский

Citations

9
Critical warm ischemia time point for cardiac donation after circulatory death DOI Creative Commons

Silvia Sánchez-Cámara,

M. Lopez, Mario Royo-Villanova

et al.

American Journal of Transplantation, Journal Year: 2022, Volume and Issue: 22(5), P. 1321 - 1328

Published: Feb. 3, 2022

Donation after circulatory death (DCD) represents a promising opportunity to overcome the relative shortage of donors for heart transplantation. However, necessary period warm ischemia is concern. This study aims determine critical time based on in vivo biochemical changes. Sixteen DCD non-cardiac donors, without cardiovascular disease, underwent serial endomyocardial biopsies immediately before withdrawal life-sustaining therapy (WLST), at arrest (CA) and every 2 min thereafter. Samples were processed into representative pools assess calcium homeostasis, mitochondrial function cellular viability. Compared baseline, no significant deterioration was observed any studied parameter CA (median: 9 min; IQR: 7-13 range: 4-19 min). Ten CA, phosphorylation cAMP-dependent protein kinase-A Thr197 SERCA2 decreased markedly; parallelly, complex II IV activities decreased, caspase 3/7 activity raised significantly. These results did not differ when with higher WLST times (≥9 min) analyzed separately. In human cardiomyocytes, from first 10 associated compromise or findings may help incorporate transplant programs.

Language: Английский

Citations

36
Knowledge gaps in heart and lung donation after the circulatory determination of death: Report of a workshop of the National Heart, Lung, and Blood Institute DOI
James L. Bernat, Kiran K. Khush, Sam D. Shemie

et al.

The Journal of Heart and Lung Transplantation, Journal Year: 2024, Volume and Issue: 43(6), P. 1021 - 1029

Published: March 2, 2024

Language: Английский

Citations

6
Outcomes of Heart Transplantation From Donation After Circulatory Death: An Up-to-date Systematic Meta-analysis DOI

Junjie Zong,

Weicong Ye, Jizhang Yu

et al.

Transplantation, Journal Year: 2024, Volume and Issue: 108(9), P. e264 - e275

Published: April 5, 2024

Background. Donation after circulatory death (DCD) heart transplantation (HTx) significantly expands the donor pool and reduces waitlist mortality. However, high-level evidence-based data on its safety effectiveness are lacking. This meta-analysis aimed to compare outcomes between DCD donation brain (DBD) HTxs. Methods. Databases, including MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, were systematically searched for randomized controlled trials observational studies reporting DBD HTxs published from 2014 onward. The pooled using random-effects models. Risk ratios (RRs) with 95% confidence intervals (CIs) used as summary measures categorical mean differences continuous outcomes. Results. Twelve eligible included in meta-analysis. HTx was associated lower 1-y mortality rate (DCD 8.13% versus 10.24%; RR = 0.75; CI, 0.59-0.96; P 0.02) 5-y 14.61% 20.57%; 0.72; 0.54-0.97; 0.03) compared HTx. Conclusions. Using current criteria, emerges a promising alternative transplantation. feasibility hearts deserve further exploration investigation.

Language: Английский

Citations

6
Bridging the gap between in vitro and in vivo models: a way forward to clinical translation of mitochondrial transplantation in acute disease states DOI Creative Commons

David F. Bodenstein,

Gabriel Siebiger,

Yimu Zhao

et al.

Stem Cell Research & Therapy, Journal Year: 2024, Volume and Issue: 15(1)

Published: May 31, 2024

Abstract Mitochondrial transplantation and transfer are being explored as therapeutic options in acute chronic diseases to restore cellular function injured tissues. To limit potential immune responses rejection of donor mitochondria, current clinical applications have focused on delivery autologous mitochondria. We recently convened a Transplant Convergent Working Group (CWG), explore three key issues that translation: (1) storage (2) biomaterials enhance mitochondrial uptake, (3) dynamic models mimic the complex recipient tissue environment. In this review, we present summary CWG conclusions related these provide an overview pre-clinical studies aimed at building more robust toolkit for translational trials.

Language: Английский

Citations

6
Heart Donation and Preservation: Historical Perspectives, Current Technologies, and Future Directions DOI Open Access
Nicholas R. Hess, Luke A. Ziegler,

David J. Kaczorowski

et al.

Journal of Clinical Medicine, Journal Year: 2022, Volume and Issue: 11(19), P. 5762 - 5762

Published: Sept. 28, 2022

Heart transplantation has become the accepted treatment for advanced heart failure, with over 4000–5000 performed in world annually. Although number of yearly transplants been increasing last decade, candidates need continues to grow at an even faster rate. To distribute these scarce and precious resources equitably, donor placement is based on clinical priority given those who are more critically ill. As a result, donors matched recipient increasingly farther distances, which may subject organs longer ischemic times. One mainstays successful organ preservation while ex vivo from time procurement implantation. In order adapt new era where shared across wider ranges, strategies must evolve accommodate ischemia times mitigating harmful sequalae ischemia-reperfusion injury. Additionally, address ever-growing supply demand mismatch organs, evolving perfusion technologies allow further evaluation grafts outside conventional acceptance practices, thus enlarging effective pool. Herein this review, we discuss history preservation, current modalities employed practice, along developing preclinical stages. Lastly, introduce concept donation after circulatory death (DCD), until recently largely unexplored avenue that relies much techniques.

Language: Английский

Citations

28
Donation After Circulatory Death: A New Frontier DOI Creative Commons
Yashutosh Joshi, J. Villanueva, Ling Gao

et al.

Current Cardiology Reports, Journal Year: 2022, Volume and Issue: 24(12), P. 1973 - 1981

Published: Oct. 22, 2022

To highlight the current global experience with DCD heart transplantation and explore evolution of, compare preservation strategies; examine early clinical outcomes, discuss growing use of donors as a new frontier in transplantation.

Language: Английский

Citations

20