Ice, ice, maybe? Is it time to ditch the igloo cooler? Benefits of machine perfusion preservation of donor hearts

R, Vela; Jessen, Michael E.; Peltz, Matthias

doi:10.1111/aor.13599

Cited by 9 publications

(6 citation statements)

References 64 publications

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“…The first challenge concerns meeting the metabolic demands of the heart graft; some kidney HMP systems do not require perfusate oxygenation, but this capacity is essential to meet the heart's extraordinary oxygen demand even at reduced temperatures. There is evidence that oxygenator flow rates of 10 mL/100 g of cardiac tissue per minute are adequate to meet these demands, but whether such flow rates increase oxygen‐mediated myocyte damage remains unclear 88 . A second challenge concerns organ assessment; viability assessment is presently limited to biochemical perfusate analysis, which provides minimal information about the functional status of the graft.…”

Section: Clinical Data and Discussion: Kidneymentioning

confidence: 99%

“…The second reality is that cardiac HMP technologies have the capacity to convert to SCS in the event of perfusion malfunction with a high likelihood of graft salvage. The third is that cardiac HMP devices are no larger than a cooler and additional transport requirements are minimal 88 …”

Section: Clinical Data and Discussion: Kidneymentioning

confidence: 99%

“…Although energetically costly, cardiac NMP offers monitoring and adjustment capacities that are not available with HMP. Both HMP and NMP can perform blood gas and biochemical perfusate analysis, but only NMP offers coronary blood flow measurements, EKG and blood pressure monitoring capacities, and one day may allow for echocardiography and catheterization 88 . Using these tools to make contractility assessments requires either normothermic or near‐normothermic conditions, so preservation strategies that closely mimic physiologic conditions are paramount to making an accurate functional evaluation 92 .…”

Section: Clinical Data and Discussion: Kidneymentioning

confidence: 99%

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Machine perfusion of donor organs for transplantation

et al. 2021

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The ever‐widening gap between organ supply and demand has resulted in an organ shortage crisis that affects patients all over the world. For decades, static cold storage (SCS) was the gold standard preservation strategy because of its simplicity and cost‐effectiveness, but the rising unmet demand for donor organ transplants has prompted investigation into preservation strategies that can expand the available donor pool. Through ex vivo functional assessment of the organ prior to transplant, newer methods to preserve organs such as perfusion‐based therapy can potentially expand the available organ pool. This review will explain the physiologic rationale for SCS before exploring the advantages and disadvantages associated with the two broad classes of preservation strategies that have emerged to address the crisis: hypothermic and normothermic machine perfusion. A detailed analysis of how each preservation strategy works will be provided before investigating the current status of clinical data for each preservation strategy for the kidney, liver, pancreas, heart, and lung. For some organs there is robust data to support the use of machine perfusion technologies over SCS, and in others the data are less clear. Nonetheless, machine perfusion technologies represent an exciting frontier in organ preservation research and will remain a crucial component of closing the gap between organ supply and recipient demand.

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Section: Clinical Data and Discussion: Kidneymentioning

confidence: 99%

Section: Clinical Data and Discussion: Kidneymentioning

confidence: 99%

Section: Clinical Data and Discussion: Kidneymentioning

confidence: 99%

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Machine perfusion of donor organs for transplantation

et al. 2021

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“…Tissue and organ loss to trauma, disease, and physical injury account for a large proportion of human ailments and approximately $400 billion in annual medical burden. 1 The slowing of biological activities or ‘biostasis’ can buy time for trauma and transplant patients, reduce damage from toxins and overdoses, and improve survival of cells and organs for transplantation. This is currently accomplished clinically by lowering temperature and static cold storage is the standard of care for organ and tissue preservation; however, its long-term use can cause damage to the integrity of the graft.…”

Section: Demonstration Of Stasis Induction In Xenopusmentioning

confidence: 99%

“…This is currently accomplished clinically by lowering temperature and static cold storage is the standard of care for organ and tissue preservation; however, its long-term use can cause damage to the integrity of the graft. [1][2][3] Hypothermia also has been used to induce a state of biostasis clinically using exvivo machine perfusion technologies, for example, during cardiac transplant surgery.Combination of protective agents with perfusion and/or partial freezing approaches have extended preservation times in rat livers and whole pigs, 4,5 and neural modulation approaches have been successful at demonstrating central control of body temperature and general metabolic state. 6,7 However, both mechanical cooling and neural stimulation approaches are…”

mentioning

confidence: 99%

Identification of pharmacological inducers of a reversible hypometabolic state for whole organ preservation

Sperry

Charrez

Fotowat

et al. 2023

Preprint

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An injectable 'biostasis' drug that could slow organ injury by inducing a state of suspended animation through reversible slowing of metabolic processes would have great value for organ preservation and treatment of badly injured patients at the point-of-care. Using whole-organism screening of metabolism, mobility, and development in Xenopus, we identified an existing drug, SNC80, that rapidly and reversibly slows biochemical and metabolic activities while preserving cell and tissue viability, independently of its known delta opioid receptor modulating activity. Metabolic suppression was also achieved using SNC80 in cultured cells and microfluidic human organs-on-chips, as well as in explanted whole porcine hearts and limbs, demonstrating the cross-species relevance of this approach and potential clinical relevance for surgical transplantation. Thermal proteome profiling revealed that SNC80 targets the NCX1/EEAT1 membrane transport system and chemical modulation of NCX1 induces biostasis in non-hibernating Xenopus tadpoles. Molecular induction of biostasis may offer a new therapeutic approach for organ preservation, trauma management, and enhancing patient survival in remote and low-resource locations.

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