Heart graft preservation technics and limits: an update and perspectives
Heart transplantation, the gold standard treatment for end-stage heart failure, is limited by heart graft shortage, justifying expansion of the donor pool. Currently, static cold storage (SCS) of hearts from donations after brainstem death remains the standard practice, but it is usually limited to...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1248606/full |
| _version_ | 1797635733432827904 |
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| author | Aurore Ughetto Aurore Ughetto François Roubille François Roubille Adrien Molina Adrien Molina Pascal Battistella Philippe Gaudard Philippe Gaudard Roland Demaria Julien Guihaire Alain Lacampagne Clément Delmas Clément Delmas Clément Delmas |
| author_facet | Aurore Ughetto Aurore Ughetto François Roubille François Roubille Adrien Molina Adrien Molina Pascal Battistella Philippe Gaudard Philippe Gaudard Roland Demaria Julien Guihaire Alain Lacampagne Clément Delmas Clément Delmas Clément Delmas |
| author_sort | Aurore Ughetto |
| collection | DOAJ |
| description | Heart transplantation, the gold standard treatment for end-stage heart failure, is limited by heart graft shortage, justifying expansion of the donor pool. Currently, static cold storage (SCS) of hearts from donations after brainstem death remains the standard practice, but it is usually limited to 240 min. Prolonged cold ischemia and ischemia-reperfusion injury (IRI) have been recognized as major causes of post-transplant graft failure. Continuous ex situ perfusion is a new approach for donor organ management to expand the donor pool and/or increase the utilization rate. Continuous ex situ machine perfusion (MP) can satisfy the metabolic needs of the myocardium, minimizing irreversible ischemic cell damage and cell death. Several hypothermic or normothermic MP methods have been developed and studied, particularly in the preclinical setting, but whether MP is superior to SCS remains controversial. Other approaches seem to be interesting for extending the pool of heart graft donors, such as blocking the paths of apoptosis and necrosis, extracellular vesicle therapy, or donor heart-specific gene therapy. In this systematic review, we summarize the mechanisms involved in IRI during heart transplantation and existing targeting therapies. We also critically evaluate all available data on continuous ex situ perfusion devices for adult donor hearts, highlighting its therapeutic potential and current limitations and shortcomings. |
| first_indexed | 2024-03-11T12:25:36Z |
| format | Article |
| id | doaj.art-53b23874836e4529aa1f0633224f5ee2 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-11T12:25:36Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-53b23874836e4529aa1f0633224f5ee22023-11-06T09:57:11ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-11-011010.3389/fcvm.2023.12486061248606Heart graft preservation technics and limits: an update and perspectivesAurore Ughetto0Aurore Ughetto1François Roubille2François Roubille3Adrien Molina4Adrien Molina5Pascal Battistella6Philippe Gaudard7Philippe Gaudard8Roland Demaria9Julien Guihaire10Alain Lacampagne11Clément Delmas12Clément Delmas13Clément Delmas14Phymedexp INSERM, CNRS, University of Montpellier, CHRU Montpellier, Montpellier, FranceDepartment of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, FrancePhymedexp INSERM, CNRS, University of Montpellier, CHRU Montpellier, Montpellier, FranceCardiology Department, CHU de Montpellier, University of Montpellier, Montpellier, FrancePhymedexp INSERM, CNRS, University of Montpellier, CHRU Montpellier, Montpellier, FranceCardio-thoracic and Vascular Surgery Department, CHU de Montpellier, University of Montpellier, Montpellier, FranceCardio-thoracic and Vascular Surgery Department, CHU de Montpellier, University of Montpellier, Montpellier, FrancePhymedexp INSERM, CNRS, University of Montpellier, CHRU Montpellier, Montpellier, FranceDepartment of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, FranceCardio-thoracic and Vascular Surgery Department, CHU de Montpellier, University of Montpellier, Montpellier, FranceCardiac and Vascular Surgery, Marie Lanelongue Hospital, Paris Saclay University, Le Plessis Robinson, FrancePhymedexp INSERM, CNRS, University of Montpellier, CHRU Montpellier, Montpellier, FrancePhymedexp INSERM, CNRS, University of Montpellier, CHRU Montpellier, Montpellier, FranceIntensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, Toulouse, FranceREICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, FranceHeart transplantation, the gold standard treatment for end-stage heart failure, is limited by heart graft shortage, justifying expansion of the donor pool. Currently, static cold storage (SCS) of hearts from donations after brainstem death remains the standard practice, but it is usually limited to 240 min. Prolonged cold ischemia and ischemia-reperfusion injury (IRI) have been recognized as major causes of post-transplant graft failure. Continuous ex situ perfusion is a new approach for donor organ management to expand the donor pool and/or increase the utilization rate. Continuous ex situ machine perfusion (MP) can satisfy the metabolic needs of the myocardium, minimizing irreversible ischemic cell damage and cell death. Several hypothermic or normothermic MP methods have been developed and studied, particularly in the preclinical setting, but whether MP is superior to SCS remains controversial. Other approaches seem to be interesting for extending the pool of heart graft donors, such as blocking the paths of apoptosis and necrosis, extracellular vesicle therapy, or donor heart-specific gene therapy. In this systematic review, we summarize the mechanisms involved in IRI during heart transplantation and existing targeting therapies. We also critically evaluate all available data on continuous ex situ perfusion devices for adult donor hearts, highlighting its therapeutic potential and current limitations and shortcomings.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1248606/fullPGF primary graft failureMP machine perfusionESNP ex situ normothermic perfusionheart tranplantationheart preservationhypothermic machine perfusion (HMP) |
| spellingShingle | Aurore Ughetto Aurore Ughetto François Roubille François Roubille Adrien Molina Adrien Molina Pascal Battistella Philippe Gaudard Philippe Gaudard Roland Demaria Julien Guihaire Alain Lacampagne Clément Delmas Clément Delmas Clément Delmas Heart graft preservation technics and limits: an update and perspectives Frontiers in Cardiovascular Medicine PGF primary graft failure MP machine perfusion ESNP ex situ normothermic perfusion heart tranplantation heart preservation hypothermic machine perfusion (HMP) |
| title | Heart graft preservation technics and limits: an update and perspectives |
| title_full | Heart graft preservation technics and limits: an update and perspectives |
| title_fullStr | Heart graft preservation technics and limits: an update and perspectives |
| title_full_unstemmed | Heart graft preservation technics and limits: an update and perspectives |
| title_short | Heart graft preservation technics and limits: an update and perspectives |
| title_sort | heart graft preservation technics and limits an update and perspectives |
| topic | PGF primary graft failure MP machine perfusion ESNP ex situ normothermic perfusion heart tranplantation heart preservation hypothermic machine perfusion (HMP) |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1248606/full |
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