Development of an ex vivo technique to achieve reanimation of hearts sourced from a porcine donation after circulatory death model

Mownah, O.; Khurram, Muhammad; Ray, Christopher; Kanwar, Aditya; Stamp, S; Rees, D; Brassil, J; Majó, Joaquim; Dark, John H.; Carter, Noel M.; Talbot, David

doi:10.1016/j.jss.2014.02.041

Cited by 15 publications

(4 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some drawbacks of VSOP, however, are the potential formation of gaseous emboli and the low potential for waste removal and nutrient supply when compared to MP and OMP [11,35]. In reports comparing VSOP, MP, and CS for preservation of the liver, heart, and pancreas, it was concluded that VSOP provided a superior preservation quality [16,36,37]. For application of OMP, several devices have been developed, with promising results reported from experimental studies in anticipation of clinical trials [9,19,38,39].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Aerobic Preservation by Venous Systemic Oxygen Persufflation or Oxygenated Machine Perfusion of Warm-Ischemia-Damaged Porcine Kidneys

Kalenski

Mancina²,

Paschenda³

et al. 2016

Eur Surg Res

View full text Add to dashboard Cite

Background/Aim: The global shortage of donor organs for transplantation has necessitated the expansion of the organ pool through increased use of organs from less ideal donors. Venous systemic oxygen persufflation (VSOP) and oxygenated machine perfusion (OMP) have previously demonstrated beneficial results compared to cold storage (CS) in the preservation of warm-ischemia-damaged kidney grafts. The aim of this study was to compare the efficacy of VSOP and OMP for the preservation of warm-ischemia-damaged porcine kidneys using the recently introduced Ecosol preservation solution compared to CS using Ecosol or histidine-tryptophan-ketoglutarate solution (HTK). Materials and Methods: Kidneys from German Landrace pigs (n = 5/group) were retrieved and washed out with either Ecosol or HTK after 45 min of clamping of the renal pedicle. As controls, kidneys without warm ischemia, cold stored for 24 h in HTK, were employed. Following 24 h of preservation by VSOP, OMP, CS-Ecosol, or CS-HTK, renal function and damage were assessed during 1 h using the isolated perfused porcine kidney model. Results: During reperfusion, urine production was significantly higher in the VSOP and OMP groups than in the CS-HTK group; however, only VSOP could demonstrate lower urine protein concentrations and fractional excretion of sodium, which did not differ from the non-warm-ischemia-damaged control group. VSOP, CS-Ecosol, and controls showed better maintenance of the acid-base balance than CS-HTK. Reduced lipid peroxidation, as reflected in postreperfusion tissue thiobarbituric acid-reactive substance levels, was observed in the VSOP group compared to the OMP group, and the VSOP and CS-Ecosol groups had concentrations similar to the controls. The ratio of reduced to oxidized glutathione was higher in the VSOP, OMP, and CS-Ecosol groups than in the CS-HTK group and controls, with a higher ratio in the VSOP than in the OMP group. Conclusion: VSOP was associated with mitigation of oxidative stress in comparison to OMP and CS. Preservation of warm-ischemia-damaged porcine kidneys by VSOP was improved compared to OMP and CS, and was comparable to preservation of non-warm-ischemia-damaged cold-stored kidneys.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of Aerobic Preservation by Venous Systemic Oxygen Persufflation or Oxygenated Machine Perfusion of Warm-Ischemia-Damaged Porcine Kidneys

Kalenski

Mancina²,

Paschenda³

et al. 2016

Eur Surg Res

View full text Add to dashboard Cite

show abstract

“…27,31 Interestingly, similar results were observed in normothermic perfusion of laboratory porcine hearts. 32 The limitations of the hollow fiber dialyzer, however, are the need for a countercurrent and a dialyzer machine. This results in a higher complexity of the perfusion setup compared with the relatively simple addition of a hemofiltrator, which might limit its clinical use due to the necessity of transportation while on perfusion.…”

Section: Discussionmentioning

confidence: 99%

Hemofiltration Improves Blood Perfusate Conditions Leading to Improved Ex Situ Heart Perfusion

Kaffka genaamd Dengler,

Mishra,

Vervoorn

et al. 2023

ASAIO Journal

View full text Add to dashboard Cite

The aim was to optimize the perfusate composition by including a hemofiltrator to the PhysioHeartplatform for ex situ heart perfusion of porcine slaughterhouse hearts. Fourteen hearts were harvested from Dutch Landrace pigs and slaughtered for human consumption. All hearts were preserved for 4 hours using static cold storage before reperfusion for 4 hours on the PhysioHeart platform. Seven hearts were assigned to the hemofiltration group, where a hemofiltrator was added to the perfusion circuit, while the control group did not receive hemofiltration. In the hemofiltration group, the perfusion fluid was filtrated for 1 hour with a flow of 1 L/hour before reperfusion. After mounting the heart, hemofiltration was maintained at 1 L/hour, and cardiac function and blood samples were analyzed at multiple time points. Preserved cardiac function was defined as a cardiac output >3.0 L/min with a mean aortic pressure >60 mm Hg and a left atrial pressure <15 mm Hg. Hemofiltration resulted in a significantly reduced potassium concentration at all time points (p < 0.001), while sodium levels remained at baseline values (p < 0.004). Furthermore, creatinine and ammonia levels decreased over time. Functional assessment demonstrated a reduced left atrial pressure (p < 0.04) and a reduction of the required dobutamine dose to support myocardial function (p < 0.003) in the hemofiltration group. Preserved cardiac function did not differ between groups. Hemofiltration results in an improved biochemical composition of the whole blood perfusate and preserves cardiac function better during normothermic perfusion based on a reduced left atrial pressure (LAP) and dobutamine requirement to support function.

show abstract

“…Short preservation windows heavily constrain organ use, resulting directly in the discard of thousands of organs [ 31 ], placing constraints on transplant centers’ ability to respond to an organ offer [ 38 ], and impeding optimal donor–recipient matching [ 39 ] and organ assessment [ 40 ▪▪ , 41 ▪ ] (Table 1 ). Additionally, perfusion-based preservation platforms have enabled the rehabilitation of otherwise unsuitable organs by repairing a great variety of defects [ 10 , 42 , 43 ▪ , 44 – 52 ], even resulting in the successful transplantation of donor hearts after circulatory death [ 48 , 53 , 54 , 55 ▪ , 56 ▪▪ ]. This offers the promise of increasing organ utilization and dramatically widening the pool of organ donors, ameliorating the organ shortage.…”

Section: Addressing the Organ Shortagementioning

confidence: 99%

Social, economic, and policy implications of organ preservation advances

Ward

Klassen²,

Franz

et al. 2018

Current Opinion in Organ Transplantation

View full text Add to dashboard Cite

Purpose of reviewDespite over 60 years of progress in the field of since the first organ transplant, insufficient organ preservation capabilities still place profound constraints on transplantation. These constraints play multiple and compounding roles in the predominant limitations of the field: the severe shortages of transplant organs, short-term and long-term posttransplant outcomes and complications, the unmet global need for development of transplant infrastructures, and economic burdens that limit patient access to transplantation and contribute to increasing global healthcare costs. This review surveys ways that advancing preservation technologies can play a role in each of these areas, ultimately benefiting thousands if not millions of patients worldwide.Recent findingsPreservation advances can create a wide range of benefits across many facets of organ transplantation, as well as related areas of transplant research. As these technologies mature, so will the policies around their use to maximize the benefits offered by organ preservation.SummaryOrgan preservation advances stand to increase local and global access to transplantation, improve transplant outcomes, and accelerate progress in related areas such as immune tolerance induction and xenotransplantation. This area holds the potential to save the healthcare system many billions of dollars and reduce costs across many aspects of transplantation. Novel preservation technologies, along with other technologies facilitated by preservation advances, could potentially save millions of lives in the coming years.

show abstract

Development of an ex vivo technique to achieve reanimation of hearts sourced from a porcine donation after circulatory death model

Cited by 15 publications

References 27 publications

Comparison of Aerobic Preservation by Venous Systemic Oxygen Persufflation or Oxygenated Machine Perfusion of Warm-Ischemia-Damaged Porcine Kidneys

Comparison of Aerobic Preservation by Venous Systemic Oxygen Persufflation or Oxygenated Machine Perfusion of Warm-Ischemia-Damaged Porcine Kidneys

Hemofiltration Improves Blood Perfusate Conditions Leading to Improved Ex Situ Heart Perfusion

Social, economic, and policy implications of organ preservation advances

Contact Info

Product

Resources

About