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da Silva GMA, Wagner MJ, Hatami S, Hassanzadeh P, Wang X, Adam BA, Nagendran J, Freed DH. Evaluation of target temperature on effectiveness of myocardial preservation during hypothermic machine perfusion. JHLT OPEN 2025; 8:100234. [PMID: 40144719 PMCID: PMC11935436 DOI: 10.1016/j.jhlto.2025.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/28/2025]
Abstract
Background Ex-situ heart perfusion (ESHP) has been proposed as an optimal method for preserving donated hearts prior to transplantation. Hypothermic oxygenated perfusion (HOP) is a simple method from a device design perspective, with enhanced safety compared to normothermic perfusion in the event of device failure. However, the optimal temperature for cardiac HOP has yet to be determined. We evaluated the effectiveness of 12-hour HOP using University of Wisconsin Machine Perfusion Solution (UWMPS) in different temperatures compared to static cold storage (SCS) for 6 hours followed by simulated transplantation. Additionally, we sought to determine the impact of oxygen supplementation in hypothermic ESHP in the heart function preservation. Methods Hearts were procured from Yorkshire pigs (n = 35) randomized into 3 preservation therapies: 6 hours-SCS; 12 hours-HOP and 12 hours hypothermic non-oxygenated perfusion (HNOP-without oxygen supplementation). For either HOP or HNOP groups, 3 temperatures were tested (5°C; 10°C; 15°C). After the preservation period, hearts had their function assessed in a normothermic perfusion machine capable of working mode, simulating transplantation. Results All perfusion parameters were stable throughout (mean ± SD): aortic flow 65 ± 5.57 ml/min, aortic pressure: 11.51 ± 3.17 mm Hg. All HOP hearts presented a better cardiac index than SCS (p < 0.05). The HNOP hearts presented similar cardiac function results compared to SCS. Conclusions HOP for 12 hours had better heart function preservation than SCS for 6 hours. Even HNOP had similar results compared to SCS. Greater edema formation in ESHP hearts did not affect heart function. Hypothermic ESHP safely enhances function preservation compared to SCS.
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Affiliation(s)
| | - Mitchell J. Wagner
- Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sanaz Hatami
- Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Parham Hassanzadeh
- Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Xiuhua Wang
- Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin A. Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
- Alberta Transplant Institute, Edmonton, Alberta, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Darren H. Freed
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
- Alberta Transplant Institute, Edmonton, Alberta, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
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2
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Martins PN, Edil BH, McNally L, Battula NR. Expanding the Use of Ex Situ Organ Machine Perfusion Beyond Transplantation. Artif Organs 2025. [PMID: 40259786 DOI: 10.1111/aor.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 02/10/2025] [Accepted: 03/25/2025] [Indexed: 04/23/2025]
Abstract
Machine perfusion preservation of grafts has become the gold standard organ preservation method. It has been developed to improve the quality of grafts due to the increasing gap between demand and supply of organs for transplantation. Following successful long-term machine perfusion preservation with automated commercial devices developed for preservation of organs for transplantation, there is increasing interest in utilizing perfused discarded human organs and xenografts for a variety of purposes beyond transplantation including gene therapy and modulation, drug testing, chemotherapy, ex vivo surgery, organ supporting systems, bioengineering, and surgical training and education. Here, we review all current and potential applications of machine perfusion preservation.
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Affiliation(s)
- Paulo N Martins
- Department of Surgery, Transplantation Institute, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Barish H Edil
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Lacey McNally
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Narendra R Battula
- Department of Surgery, Transplantation Institute, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
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3
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Johnson B, Martin M, Reagor J, Tung A. Thirty Years of Perfusion Licensure in the United States: Exploring Current Concepts and Developing New Strategies for the Future. J Cardiothorac Vasc Anesth 2025:S1053-0770(25)00083-7. [PMID: 40021441 DOI: 10.1053/j.jvca.2025.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 01/05/2025] [Accepted: 01/20/2025] [Indexed: 03/03/2025]
Abstract
Over the past 30 years, licensure and certification requirements for cardiovascular perfusionists have varied considerably in the United States. In addition to intraoperative perfusion for cardiac surgery, the role of cardiovascular perfusion has recently expanded to include extracorporeal membrane oxygenation and the management of organ recovery systems used for transplantation. Efforts by organizations such as the American Society of ExtraCorporeal Technology and the American Board of Cardiovascular Perfusion have led to the recognition of perfusion as a distinct allied health profession in many states. However, in other states, perfusionists remain less regulated, potentially compromising patient safety . This work will review the current perfusion licensure landscape in the United States and suggest strategies to regulate an increasingly complex and technological profession . We describe successful experiences from licensed and unlicensed states and highlight national variations in adoption. These examples emphasize the importance of ongoing legislative and regulatory focus on perfusion and the potential positive impact of active perfusion licensure. As the role of the certified clinical perfusionist evolves, innovative technologies and techniques such as extracorporeal membrane oxygenation, ex situ organ perfusion, in vivo lung perfusion, and normothermic regional perfusion continue to expand the scope of perfusion practice. One strategy to improve the quality of perfusion services nationwide is the broad adoption and implementation of compact perfusion licensure, an agreement between states allowing licensed professionals to practice in multiple states while maintaining a single license. Such a compact would pave the way for a more consistent and safer practice across states, underscoring the necessity of a multidisciplinary approach between perfusionists, anesthesiologists, and surgeons in improving patient safety.
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Affiliation(s)
- Blaine Johnson
- Perfusion Services, UChicago Medicine, Chicago, IL, United States; Perfusion Education Program, University of Iowa Carver College of Medicine, Iowa City, IA, United States.
| | - Mark Martin
- Redline Perfusion & Consulting, LLC, Gainesville, FL, United States
| | - James Reagor
- Department of Cardiovascular Perfusion, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Avery Tung
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, United States
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4
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Gardiner D, McGee A, Kareem Al Obaidli AA, Cooper M, Lentine KL, Miñambres E, Nagral S, Opdam H, Procaccio F, Shemie SD, Spiro M, Torres M, Thomson D, Waterman AD, Domínguez-Gil B, Delmonico FL. Developing and Expanding Deceased Organ Donation to Its Maximum Therapeutic Potential: An Actionable Global Challenge From the 2023 Santander Summit. Transplantation 2025; 109:10-21. [PMID: 39437375 DOI: 10.1097/tp.0000000000005234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
On November 9 and 10, 2023, the Organización Nacional de Trasplantes (ONT), under the Spanish Presidency of the Council of the European Union, convened in Santander a Global Summit entitled "Towards Global Convergence in Transplantation: Sufficiency, Transparency and Oversight." This article summarizes two distinct but related challenges elaborated at the Santander Summit by Working Group 2 that must be overcome if we are to develop and expand deceased donation worldwide and achieve the goal of self-sufficiency in organ donation and transplantation. Challenge 1: the need for a unified concept of death based on the permanent cessation of brain function. Working group 2 proposed that challenge 1 requires the global community to work toward a uniform, worldwide definition of human death, conceptually unifying circulatory and neurological criteria of death around the cessation of brain function and accepting that permanent cessation of brain function is a valid criterion to determine death. Challenge 2: reducing disparities in deceased donation and increasing organ utilization through donation after the circulatory determination of death (DCDD). Working group 2 proposed that challenge 2 requires the global community to work toward increasing organ utilization through DCDD, expanding DCDD through in situ normothermic regional perfusion, and expanding DCDD through ex situ machine organ perfusion technology. Recommendations for implementation are described.
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Affiliation(s)
- Dale Gardiner
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Bristol, United Kingdom
| | - Andrew McGee
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia
| | | | | | - Krista L Lentine
- SSM Health Saint Louis University Transplant Center, St. Louis, MO
| | - Eduardo Miñambres
- Donor Transplant Coordination Unit and Service of Intensive Care, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, Universidad de Cantabria, Santander, Spain
| | - Sanjay Nagral
- Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Helen Opdam
- National Medical Director, Organ and Tissue Authority, Canberra & Intensive Care Specialist, Austin Health, Melbourne, Australia
| | | | - Sam D Shemie
- Pediatric Critical Care Medicine, McGill University Health Centre, Montreal, QB, Canada
- Canadian Blood Services, Ottawa, ON, Canada
| | - Michael Spiro
- Royal Free Hospital, Hampstead, London & Division of Surgery, University College London, London, UK
| | - Martín Torres
- Instituto Nacional Central Único de Ablación e Implante (INCUCAI), Ministry of Health, Buenos Aires, Argentina
| | - David Thomson
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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5
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Amarelli C, Bello I, Aigner C, Berman M, Boffini M, Clark S, Dalvindt M, de Wolf J, Ensminger S, Gomez de Antonio D, Hoyos L, Palmieri L, Schweiger M, Sponga S, Wiegmann B, Neyrinck A, the ESOT Guidelines Taskforce. European Society of Organ Transplantation (ESOT) Consensus Statement on Machine Perfusion in Cardiothoracic Transplant. Transpl Int 2024; 37:13112. [PMID: 39649067 PMCID: PMC11620879 DOI: 10.3389/ti.2024.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 09/26/2024] [Indexed: 12/10/2024]
Abstract
The machine perfusion (MP) of transplantable grafts has emerged as an upcoming field in Cardiothoracic (CT) transplantation during the last decade. This technology carries the potential to assess, preserve, and even recondition thoracic grafts before transplantation, so it is a possible game-changer in the field. This technology field has reached a critical turning point, with a growing number of publications coming predominantly from a few leading institutions, but still need solid scientific evidence. Due to the increasing need to expand the donor pool, especially in Europe, where the donor age is steeply increased, a consensus has been established to address the growing need and knowledge of machine perfusion in cardiothoracic transplantation, targeting the unmet scientific need in this growing field but also, priorities for development, and regional differences in utilization rates and organizational issues. To address MP in CT, the European Society of Organ Transplantation (ESOT) convened a dedicated Working group comprised of experts in CT to review literature about MP to develop guidelines that were subsequently discussed and voted on during the Consensus Conference that took place in person in Prague during the TLJ 3.0 in November 2022. The findings and recommendations of the Cardiothoracic Working Group on MP are presented in this article.
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Affiliation(s)
- Cristiano Amarelli
- Department of Cardiac Surgery and Transplants, Monaldi, Azienda dei Colli, Naples, Italy
| | - Irene Bello
- Institut Clínic Respiratorio, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Marius Berman
- Transplant Unit, Royal Papworth Hospital, NHS Foundation Trust, Cambridge, United Kingdom
| | - Massimo Boffini
- Cardiac Surgery Division, Surgical Sciences Department, Citta della Salute e della Scienza, University of Torino, Turin, Italy
| | - Stephen Clark
- Department Cardiothoracic Transplant, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marita Dalvindt
- Department of Cardiothoracic Surgery, Lund University, Lund, Sweden
| | - Julien de Wolf
- Department of Thoracic Surgery, Lung Heart Institute, University Hospital of Lille, Lille, France
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, Lübeck, Germany
| | - David Gomez de Antonio
- Department of Thoracic Surgery, Puerta de Hierro University Hospital Majadahonda, Madrid, Spain
| | - Lucas Hoyos
- Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Lucrezia Palmieri
- Department of Translational Medical Sciences, Monaldi Hospital, University of Campania “Luigi Vanvitelli“, Naples, Italy
| | - Martin Schweiger
- Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Sandro Sponga
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Bettina Wiegmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Arne Neyrinck
- Department of Cardiovascular Sciences, Anesthesiology and Algology, KU Leuven, Leuven, Belgium
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6
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Berishvili E, Piemonti L, de Koning EJP, Lindstedt S, Scholz H, Scott WE, Auxenfans C, Johnson P, Martin DE, Gunther P, Mey D, Potena L, Thaunat O. ESOT Roadmap for Advanced Therapy Medicinal Products in Transplantation: Navigating Regulatory Challenges to Enhance Access and Care. Transpl Int 2024; 37:13485. [PMID: 39469665 PMCID: PMC11513584 DOI: 10.3389/ti.2024.13485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/19/2024] [Indexed: 10/30/2024]
Abstract
The field of organ transplantation is experiencing a transformative shift with the rise of Advanced Therapy Medicinal Products (ATMPs), which include gene therapies, somatic cell therapies, and tissue-engineered products. These therapies offer new, potentially curative treatments for longstanding medical challenges, impacting numerous patients. However, their adoption is hindered by complex regulatory frameworks, high production costs, and inconsistent access across Europe. The ESOT ATMP Task Force's position paper analyzes these challenges from research to clinical application, advocating for a coordinated strategy to position Europe as a leader in ATMP development. It proposes specific actions such as streamlining regulatory pathways to accelerate approvals, boosting funding for ATMP research, and creating specialized facilities for development and implementation. The paper also highlights the critical roles of patient engagement and real-world evidence in optimizing clinical and regulatory practices.
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Affiliation(s)
- Ekaterine Berishvili
- Cell Isolation and Transplantation Centre, Department of Surgery, Geneva University Hospitals, Laboratory of Tissue Engineering and Organ Regeneration, Department of Surgery, University of Geneva, Geneva, Switzerland
| | - Lorenzo Piemonti
- Diabetes Research Institute, IVita-Salute San Raffaele University, Milan, Italy
| | - Eelco J. P. de Koning
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Sandra Lindstedt
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund, Sweden
| | - Hanne Scholz
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, Oslo, Norway
| | - William E. Scott
- Regenerative Medicine, Stem Cells, and Transplantation Theme, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Celine Auxenfans
- Banque de Tissus et de Cellules des Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Paul Johnson
- Oxford Consortium for Islet Transplantation, Oxford Centre for Diabetes, Endocrinology, and Metabolism (OCDEM), Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Dominique E. Martin
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, VIC, Australia
| | | | - Devi Mey
- The European Society for Organ Transplantation, Amsterdam, Netherlands
| | - Luciano Potena
- Istituto di Ricovero e Cura a Carattere Scientifico (Scientific Institute for Research, Hospitalization, and Healthcare) (IRCCS) University Hospital of Bologna Sant Orsola Polyclinic, Bologna, Italy
| | - Olivier Thaunat
- Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
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7
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Katsirntaki K, Hagner S, Werlein C, Braubach P, Jonigk D, Adam D, Hidaji H, Kühn C, Falk CS, Ruhparwar A, Wiegmann B. Low-Volume Ex Situ Lung Perfusion System for Single Lung Application in a Small Animal Model Enables Optimal Compliance With " Reduction" in 3R Principles of Animal Research. Transpl Int 2024; 37:13189. [PMID: 39314923 PMCID: PMC11418019 DOI: 10.3389/ti.2024.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024]
Abstract
Ex situ lung perfusion (ESLP) is used for organ reconditioning, repair, and re-evaluation prior to transplantation. Since valid preclinical animal models are required for translationally relevant studies, we developed a 17 mL low-volume ESLP for double- and single-lung application that enables cost-effective optimal compliance "reduction" of the 3R principles of animal research. In single-lung mode, ten Fischer344 and Lewis rat lungs were subjected to ESLP and static cold storage using STEEN or PerfadexPlus. Key perfusion parameters, thermal lung imaging, blood gas analysis (BGA), colloid oncotic pressure (COP), lung weight gain, histological work-up, and cytokine analysis were performed. Significant differences between perfusion solutions but not between the rat strains were detected. Most relevant perfusion parameters confirmed valid ESLP with homogeneous lung perfusion, evidenced by uniform lung surface temperature. BGA showed temperature-dependent metabolic activities with differences depending on perfusion solution composition. COP is not decisive for pulmonary oedema and associated weight gain, but possibly rather observed chemokine profile and dextran sensitivity of rats. Histological examination confirmed intact lung architecture without infarcts or hemorrhages due to optimal organ procurement and single-lung application protocol using our in-house-designed ESLP system.
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Affiliation(s)
- K. Katsirntaki
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
| | - S. Hagner
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
| | - C. Werlein
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - P. Braubach
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - D. Jonigk
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, RWTH Aachen Medical University, Aachen, Germany
| | - D. Adam
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
| | - H. Hidaji
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
| | - C. Kühn
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
| | - C. S. Falk
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - A. Ruhparwar
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - B. Wiegmann
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
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8
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Kneifel F, Vondran F, Vogel T. [Machine perfusion in transplantation surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:610-617. [PMID: 39052038 DOI: 10.1007/s00104-024-02122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/27/2024]
Abstract
The use of machine perfusion in solid organ transplantation has developed tremendously worldwide in recent years. Although the number of randomized controlled trials in the field of organ preservation is still limited, machine perfusion has been shown to be superior to static cold storage of donor organs. Various devices for clinical use with hypothermia or normothermia are already available for most organs. Whether and which perfusion strategy is superior to the others is the subject of current clinical research. This also applies to the further evaluation of possible synergistic effects in the sequential use of the various protocols. The common goal of all dynamic perfusion technologies is to optimize organ preservation between removal and transplantation. By testing the quality of marginal donor organs prior to transplantation, it should also be possible to use these organs without exposing the patient to increased risk. This can lead to a significant expansion of the donor pool. This is particularly important in Germany, where there is an ongoing shortage of organs and restrictive legislation regarding the expansion of the donor pool. Furthermore, the perfusion technology offers the possibility to serve as a platform for other ex situ and in situ therapies on isolated organs. In addition to the conditioning of pre-damaged organs for transplantation, this could lead to further applications in the context of targeted organ therapies and also to improved transplant logistics in the future.
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Affiliation(s)
- Felicia Kneifel
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - Florian Vondran
- Klinik für Allgemein‑, Viszeral‑, Kinder- und Transplantationschirurgie, RWTH Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Thomas Vogel
- Klinik für Allgemein‑, Viszeral‑, Kinder- und Transplantationschirurgie, RWTH Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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9
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Iske J, Zhou H. Editorial: Immunosenescence in organ transplantation. FRONTIERS IN TRANSPLANTATION 2024; 3:1422358. [PMID: 38993765 PMCID: PMC11235217 DOI: 10.3389/frtra.2024.1422358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/28/2024] [Indexed: 07/13/2024]
Affiliation(s)
- Jasper Iske
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institutes of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Division of Transplant Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Hao Zhou
- Division of Transplant Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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10
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Andrijauskaite K, Veraza RJ, Lopez RP, Maxwell Z, Cano I, Cisneros EE, Jessop IJ, Basurto M, Lamberson G, Watt MD, Nespral J, Ono M, Bunegin L. Novel portable hypothermic machine perfusion preservation device enhances cardiac viability of donated human hearts. Front Cardiovasc Med 2024; 11:1376101. [PMID: 38628313 PMCID: PMC11018979 DOI: 10.3389/fcvm.2024.1376101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Heart transplant remains the gold standard treatment for patients with advanced heart failure. However, the list of patients waiting for a heart transplant continues to increase. We have developed a portable hypothermic oxygenated machine perfusion device, the VP.S ENCORE®, to extend the allowable preservation time. The purpose of this study was to test the efficacy of the VP.S. ENCORE® using deceased donors derived hearts. Methods Hearts from brain-dead donors not utilized for transplant (n = 11) were offered for research from the Texas Organ Sharing Alliance (TOSA), South and Central Texas' Organ Procurement Organization (OPO) and were preserved in the VP.S ENCORE® for 4 (n = 2), 6 (n = 3), and 8 (n = 3) hours or were kept in static cold storage (SCS) (n = 3). After preservation, the hearts were placed in an isolated heart Langendorff model for reperfusion and evaluated for cardiac function. Results The mean donor age was 37.82 ± 12.67 with the youngest donor being 19 and the oldest donor being 58 years old. SCS hearts mean weight gain (%) was -1.4 ± 2.77, while perfused at 4 h was 5.6 ± 6.04, perfused at 6 h 2.1 ± 6.04, and 8 h was 7.2 ± 10.76. Venous and arterial lactate concentrations were less than 2.0 mmol/L across all perfused hearts. Left ventricular contractility (+dPdT, mmHg/s) for 4 h (1,214 ± 1,064), 6 (1,565 ± 141.3), and 8 h (1,331 ± 403.6) were within the range of healthy human heart function. Thus, not significant as compared to the SCS group (1,597 ± 342.2). However, the left ventricular relaxation (mmHg/s) was significant in 6-hour perfused heart (p < 0.05) as compared to SCS. Gene expression analysis of inflammation markers (IL-6, IL-1β) showed no significant differences between SCS and perfused hearts, but a 6-hour perfusion led to a downregulated expression of these markers. Discussion The results demonstrate that the VP.S ENCORE® device enhances cardiac viability and exhibits comparable cardiac function to a healthy heart. The implications of these findings suggest that the VP.S ENCORE® could introduce a new paradigm in the field of organ preservation, especially for marginal hearts.
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Affiliation(s)
| | - Rafael J. Veraza
- Vascular Perfusion Solutions, Inc., San Antonio, TX, United States
| | - Riley P. Lopez
- Vascular Perfusion Solutions, Inc., San Antonio, TX, United States
| | - Zach Maxwell
- Vascular Perfusion Solutions, Inc., San Antonio, TX, United States
| | - Isabella Cano
- Vascular Perfusion Solutions, Inc., San Antonio, TX, United States
| | - Exal E. Cisneros
- Vascular Perfusion Solutions, Inc., San Antonio, TX, United States
| | - Israel J. Jessop
- Vascular Perfusion Solutions, Inc., San Antonio, TX, United States
| | - Maria Basurto
- Vascular Perfusion Solutions, Inc., San Antonio, TX, United States
| | - George Lamberson
- Vascular Perfusion Solutions, Inc., San Antonio, TX, United States
| | - Michelle D. Watt
- Vascular Perfusion Solutions, Inc., San Antonio, TX, United States
| | - Joseph Nespral
- Texas Organ Sharing Alliance (TOSA), San Antonio, TX, United States
| | - Masahiro Ono
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery and Perioperative Care, Austin Dell Medical School, University of Texas, Austin, TX, United States
| | - Leonid Bunegin
- Vascular Perfusion Solutions, Inc., San Antonio, TX, United States
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Carré J, Kerforne T, Hauet T, Macchi L. Tissue Injury Protection: The Other Face of Anticoagulant Treatments in the Context of Ischemia and Reperfusion Injury with a Focus on Transplantation. Int J Mol Sci 2023; 24:17491. [PMID: 38139319 PMCID: PMC10743711 DOI: 10.3390/ijms242417491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
Organ transplantation has enhanced the length and quality of life of patients suffering from life-threatening organ failure. Donors deceased after brain death (DBDDs) have been a primary source of organs for transplantation for a long time, but the need to find new strategies to face organ shortages has led to the broadening of the criteria for selecting DBDDs and advancing utilization of donors deceased after circulatory death. These new sources of organs come with an elevated risk of procuring organs of suboptimal quality. Whatever the source of organs for transplant, one constant issue is the occurrence of ischemia-reperfusion (IR) injury. The latter results from the variation of oxygen supply during the sequence of ischemia and reperfusion, from organ procurement to the restoration of blood circulation, triggering many deleterious interdependent processes involving biochemical, immune, vascular and coagulation systems. In this review, we focus on the roles of thrombo-inflammation and coagulation as part of IR injury, and we give an overview of the state of the art and perspectives on anticoagulant therapies in the field of transplantation, discussing benefits and risks and proposing a strategic guide to their use during transplantation procedures.
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Affiliation(s)
- Julie Carré
- Service D’Hématologie Biologique, Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France;
- INSERM 1313 Ischémie Reperfusion, Métabolisme, Inflammation Stérile en Transplantation (IRMETIST), Université de Poitiers, 86000 Poitiers, France; (T.K.); (T.H.)
| | - Thomas Kerforne
- INSERM 1313 Ischémie Reperfusion, Métabolisme, Inflammation Stérile en Transplantation (IRMETIST), Université de Poitiers, 86000 Poitiers, France; (T.K.); (T.H.)
- Service D’Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France
- FHU Survival Optimization in Organ Transplantation (SUPORT), 86000 Poitiers, France
| | - Thierry Hauet
- INSERM 1313 Ischémie Reperfusion, Métabolisme, Inflammation Stérile en Transplantation (IRMETIST), Université de Poitiers, 86000 Poitiers, France; (T.K.); (T.H.)
- FHU Survival Optimization in Organ Transplantation (SUPORT), 86000 Poitiers, France
- Service de Biochimie, Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France
| | - Laurent Macchi
- Service D’Hématologie Biologique, Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France;
- INSERM 1313 Ischémie Reperfusion, Métabolisme, Inflammation Stérile en Transplantation (IRMETIST), Université de Poitiers, 86000 Poitiers, France; (T.K.); (T.H.)
- FHU Survival Optimization in Organ Transplantation (SUPORT), 86000 Poitiers, France
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