Response to the manuscript “ex vivo donor heart preservation in heart transplantation (HTx)—Is this the solution to increase the donor pool?”

Author(s):  
Yuriy Pya ◽  
Assel Medressova ◽  
Linar Faizov ◽  
Aidyn Kuanyshbek ◽  
Rymbai Kaliyev ◽  
...  
Author(s):  
Sandro Sponga ◽  
Igor Vendramin ◽  
Uberto Bortolotti ◽  
Ugolino Livi

2020 ◽  
Vol 127 (Suppl_1) ◽  
Author(s):  
Shannon N Tessier ◽  
Luciana Da Silveira Cavalcante ◽  
Casie A Pendexter ◽  
Stephanie E Cronin ◽  
Reinier J de Vries ◽  
...  

Cardiac transplantation is the only curative therapy for patients with end-stage heart disease; however, there is a severe shortage of viable donor organs. Heart transplantation faces many interwoven challenges, including both biological factors and research limitations. For example, ischemia-reperfusion injury plays a role in early graft dysfunction and is associated with rejection episodes in heart transplantation. Moreover, experimental transplantation relies heavily on animal studies that are laborious and expensive, prohibiting the discovery of novel, bold solutions. We propose that the zebrafish, Danio rerio , would be a valuable tool for the field since it’s amenable to high-throughput screens, captures the complex structure of organs, and offers a suite of tools to monitor the biology of cardiac injury. Here, we develop a new subzero heart preservation method by strategically leveraging animal models from zebrafish to mammalian hearts. Using zebrafish larvae, we screened for agents which preserve hearts at -10°C. As a result of these screens, we identified promising preservative cocktails which restored heartbeat in 82% of larvae immediately post-recovery. Next, we excised adult zebrafish hearts and developed methods to mimic the ex vivo handling practices of hearts destined for transplant using a heart-on-a-plate assay. Using this assay, we carried forward promising agents identified in our initial zebrafish larvae screen to isolated adult zebrafish hearts that were cooled to -10°C and held for up to 24 hours. After rewarming, heart rate was restored and metabolic rate of zebrafish hearts was like time-matched controls (0.213 ± 0.047 and 0.275 ± 0.060, respectively, p = 0.200). Finally, we report our preliminary scale-up efforts whereby rodent hearts are stored for up to 24 hours at -10°C and viability were assessed by the TUNEL assay. The data shows high viability of cardiomyocytes post-preservation, as compared to controls. In summary, we present data to illustrate our efforts in leveraging the zebrafish to aid new discoveries in subzero heart preservation. Similar efforts to model heart transplantation in zebrafish may provide a different vantage point and enable us to make advances faster.


Author(s):  
S. A. Alsov ◽  
A. V. Fomichev ◽  
D. V. Doronin ◽  
V. A. Shmyrev ◽  
D. E. Osipov ◽  
...  

Heart transplantation is the gold standard for the treatment of terminal heart failure. The main method of the donor heart preservation is cold perfusion. The recommended maximum time for cold ischemia of the donor heart is 240 minutes. Exceeding this safe limit increases the risk of postoperative allograft dysfunction and death. However, there are reports positing a possibility to prolong the time of ischemia of the donor heart without a signifi cant risk of complications. The article presents the experience of successful transplantation of the donor heart with the cold ischemia time was 440 minutes.


2011 ◽  
Vol 11 (9) ◽  
pp. 1986-1988
Author(s):  
S. R. Ceresnak ◽  
D. T. Hsu ◽  
J. M. Lamour ◽  
S. Weinstein ◽  
R. H. Pass

Perfusion ◽  
1991 ◽  
Vol 6 (3) ◽  
pp. 191-202 ◽  
Author(s):  
Dereck Wheeldon

Clinical heart transplantation began in December 1967 when Cristiaan Barnard performed the first human to human heart transplant on a 57 year old man with ischaemic heart disease, in Cape Town. This ushered in a bout of enthusiastic heart transplantations world-wide over the subsequent few years which soon waned as the problems of acute rejection and infection became apparent to those who had embarked on this venture without fully understanding the complications. The importance of a well functioning donor heart cannot be overemphasized. Early donor heart failure accounts for approximately 26% of the deaths of heart transplant recipients today and there is also a steep rise in acute mortality associated with storage times in excess of two hours (9.8% < 2 hours rising to 17.6% > 4 hours), although satisfactory function has been reported in a few hearts stored for up to 6 hours.1 Careful selection and meticulous management of the donor, followed by optimal storage, are therefore essential to a satisfactory outcome.2 There is evidence that some of the problems of organ preservation are related to metabolic changes in the donor consequent upon brain death3-6 and recent ongoing studies by our own group show some benefit from hormone replacement therapy in the donor.7 There are essentially two major approaches to the problem of organ storage; metabolic inhibition resulting in reduced substrate requirements, and the supply of metabolic requirements, or a combination of both. Although nonperfusion methods currently predominate, the simplicity of these methods are overshadowed by the short safe time interval which they allow and the variable functional quality which results. The author believes that perfusion preservation methods will predominate in the future and may also allow expansion of the donor pool bywhole donor and/or ex vivo thoracic organ resuscitation.


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