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Annals of Transplantation is one of the fast-developing journals open to all scientists and fields of transplant medicine and related research. The journal is published quarterly and provides extensive coverage of the most important advances in transplantation.
Using an electronic on-line submission and peer review tracking system, Annals of Transplantation is committed to rapid review and publication. The average time... read more

Published: 2014-08-20

Preservation of Donor Hearts Using Hypothermic Oxygenated Perfusion

Sebastian G. Michel, Glenn M. La Muraglia II, Maria Lucia L. Madariaga, James S. Titus, Martin K. Selig, Evan A. Farkash, James S. Allan, Lisa M. Anderson, Joren C. Madsen

(Department of Surgery, Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, USA)

Ann Transplant 2014; 19:409-416

DOI: 10.12659/AOT.890797

Background: Hypothermic machine perfusion of donor hearts enables continuous aerobic metabolism and washout of toxic metabolic byproducts. We evaluated the effect of machine perfusion on cardiac myocyte integrity in hearts preserved for 4 h in a novel device that provides pulsatile oxygenated hypothermic perfusion (Paragonix Sherpa Perfusion™ Cardiac Transport System).
Material and Methods: Pig hearts were harvested and stored in Celsior® solution for 4 h using either conventional cold storage on ice (4-h CS, n=6) or the Sherpa device (4-h pulsatile perfusion (PP), n=6). After cold preservation, hearts were evaluated using a non-working heart Langendorff system. Controls (n=3) were reperfused immediately after organ harvest. Biopsies were taken from the apex of the left ventricle before storage, after storage, and after reperfusion to measure ATP content and endothelin-1 in the tissue. Ultrastructural analysis using electron microscopy was performed.
Results: Four-hour CS, 4-h PP, and control group did not show any significant differences in systolic or diastolic function (+dP/dt, –dP/dt, EDP). Four-hour PP hearts showed significantly more weight gain than 4-h CS after preservation, which shows that machine perfusion led to myocardial edema. Four-hour CS led to higher endothelin-1 levels after preservation, suggesting more endothelial dysfunction compared to 4-h PP.
Electron microscopy revealed endothelial cell rupture and damaged muscle fibers in the 4-h CS group after reperfusion, but the cell structures were preserved in the 4-h PP group.
Conclusions: Hypothermic pulsatile perfusion of donor hearts leads to ... read more

Keywords: Heart Transplantation, Organ Preservation, Pulsatile Flow

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