Effects of Hope (Hypothermic Oxygenated Perfusion) on Preservation of Vascular and Contractile Function in Cardiac Grafts in a Rat Model of Donation after Circulatory Death (DCD)

Egle, M; Méndez-Carmona, Natalia; Arnold, Marlène; Segiser, Adrian; Carrel, Thierry; Longnus, Sarah L.

doi:10.1016/j.healun.2021.01.677

Cited by 2 publications

(1 citation statement)

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“…Importantly, oxygenated normothermic reperfusion immediately following ischemia, as occurs in DPP, is likely not optimal. In a DCD rat model, HOPE improved cardiac recovery after warm ischemia, and was most likely mediated through multiple mechanisms, including the preservation of mitochondrial function (via succinate oxidation) [109] and nitric oxide synthase activity [110]. Furthermore, HOPE may also help to deplete toxic fatty acid intermediates accumulated during ischemia before ESHP to reduce lipotoxicity.…”

Section: Potential Metabolic-based Cardioprotective (Reperfusion) Str...mentioning

confidence: 97%

Metabolic Considerations in Direct Procurement and Perfusion Protocols with DCD Heart Transplantation

Arnold,

Do,

Davidson

et al. 2024

IJMS

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Heart transplantation with donation after circulatory death (DCD) provides excellent patient outcomes and increases donor heart availability. However, unlike conventional grafts obtained through donation after brain death, DCD cardiac grafts are not only exposed to warm, unprotected ischemia, but also to a potentially damaging pre-ischemic phase after withdrawal of life-sustaining therapy (WLST). In this review, we aim to bring together knowledge about changes in cardiac energy metabolism and its regulation that occur in DCD donors during WLST, circulatory arrest, and following the onset of warm ischemia. Acute metabolic, hemodynamic, and biochemical changes in the DCD donor expose hearts to high circulating catecholamines, hypoxia, and warm ischemia, all of which can negatively impact the heart. Further metabolic changes and cellular damage occur with reperfusion. The altered energy substrate availability prior to organ procurement likely plays an important role in graft quality and post-ischemic cardiac recovery. These aspects should, therefore, be considered in clinical protocols, as well as in pre-clinical DCD models. Notably, interventions prior to graft procurement are limited for ethical reasons in DCD donors; thus, it is important to understand these mechanisms to optimize conditions during initial reperfusion in concert with graft evaluation and re-evaluation for the purpose of tailoring and adjusting therapies and ensuring optimal graft quality for transplantation.

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Section: Potential Metabolic-based Cardioprotective (Reperfusion) Str...mentioning

confidence: 97%