Strain echocardiography for assessment of cardiac graft function following donation after circulatory death heart transplantation.

Heart transplantation continues to be the definitive treatment for end-stage heart failure, but organ availability limits access nationwide. Donation after circulatory death (DCD) hearts have shown tremendous promise as a viable avenue for expanding the donor pool. Still, the expanded utilization of DCD hearts has introduced new challenges that evaluating centers must work to address. Among these is the frequently variable and incomplete diagnostic information available on DCD donors before organ procurement. In this case report, we highlight the role of intraoperative surface echocardiography as a practical strategy for confirming organ suitability for transplant during DCD heart recovery with thoracoabdominal normothermic regional perfusion (TA-NRP). In specific circumstances where preoperative echocardiography is not feasible, but other diagnostic data support organ suitability for transplant, intraoperative surface echocardiography may serve as a valuable tool to increase organ utilization and improve access to life-saving transplantation.

Biliverdin supplementation in perfusate and preservation solution attenuates ischemia-reperfusion injury in a rat donation-after-circulatory-death heart transplantation model.

Controlled donation after circulatory death (cDCD) increases graft availability but may carry higher perioperative risk, which in situ normothermic regional perfusion (NRP) may mitigate by reducing ischemia-reperfusion injury. Evidence remains limited regarding NRP impact on PRS during liver transplantation (LT). The objective of this study was to compare the incidence of PRS and early postoperative outcomes between cDCD LT with NRP and donation after brain death (DBD) LT. This was a retrospective, single-center observational study comparing cDCD LT with NRP versus DBD LT. The primary endpoint was PRS (≥30% mean arterial pressure decrease for ≥1 min within 5 min of reperfusion). Secondary endpoints included early allograft dysfunction, acute kidney injury (AKI), rejection, biliary/vascular complications, and survival. Associations between graft type and outcomes were assessed using logistic regression (binary) and linear regression (continuous), and Cox models (time-to-event), with multivariable adjustment for clinically relevant covariates. Among 106 recipients (cDCD n = 47; DBD n = 59), PRS occurred 27 patients (25.5% versus 25.4%). Graft type was not associated with PRS after adjustment (odds ratio, 1.13; 95% confidence interval, 0.41-3.10; P = 0.81). No significant differences were observed in early allograft dysfunction, acute rejection, AKI, or biliary and vascular complications. There was 1 death in the cDCD group and 5 in the DBD group (2.1% versus 8.5%). In a standardized program using routine NRP, cDCD LT did not increase PRS risk and achieved early outcomes comparable to DBD LT. These findings suggest clinical feasibility and short-term safety of Maastricht III protocols incorporating NRP.

Heart transplantation using standard static cold storage is associated with an increased risk of organ injury if the cold ischemic time exceeds 4 to 5hours. The present study investigated an innovative approach using hypothermic oxygenated perfusion (HOPE) to extend preservation time to 24hours and assessed its impact on posttransplant graft function. This study assessed graft efficacy based on a single preservation strategy across 2 donor types as follows: (1) donation after circulatory death (DCD) (n = 8) and (2) donation after brain death (DBD) (n = 8), both followed by direct procurement and 24hours of HOPE before transplantation. After weaning from cardiopulmonary bypass (CPB), biventricular function was assessed using biventricular pressure-volume loops and pulmonary artery catheters during a 2-hour observation period. All included transplantations were successfully weaned from CPB and achieved comparable and adequate cardiac outputs (DCD: 5.0 ± 0.56L/min, DBD 4.5 ± 0.21L/min, p = 0.14). Both left (LV) and right ventricular (RV) myocardial contractility were preserved; LV end-systole elastance (Ees) was significantly higher after transplantation compared to baseline (p<0.001), whereas RV Ees showed no significant change over time (p = 0.08). No primary graft dysfunction occurred during the observation period. Twenty-four hours of HOPE preservation ensured preserved graft viability after both DCD and DBD heart transplantation in a porcine model. Our results suggest a potential to significantly extend preservation time in clinical heart transplantation.

Direct Procurement and Hypothermic Oxygenated Perfusion of Donor Hearts After Circulatory Death Using the XVIVO Heart Assist Transport System (HOPE at Heart): A Prospective, Multicenter, Multinational Proof-of-Concept Clinical Study

A New Preclinical Porcine Model to Study Pulmonary Deterioration During Uncontrolled Donation After Circulatory Death

Heart Transplantation from Donation After Circulatory Death with 20 Minutes of No-Touch Period: A Single Centre Experience

Donation After Circulatory Death (DCD) Conditions Influence Cardiac Accumulation of Fatty Acid Oxidation-Related Intermediates in a Sex Specific Manner

Temporal MicroRNA Profiling Supports Celsior Cold Preservation for Human Hearts Donated After Circulatory Death with Warm Ischemic Times of 30 Minutes or Less

Survival Following Donation After Circulatory Death and Donation After Brain Death in Heart-Kidney Transplants

Challenges in Extending Out-of-Body Time of Cardiac Grafts Using Normothermic Perfusion with a Porcine Model of Donation After Circulatory Death (DCD)

Pediatric Heart Transplantation Following Circulatory Death and Normothermic Regional Perfusion Procurement

Survival Outcomes After Lung Transplant from Donation After Brain Death versus Donation After Circulatory Death: A French National Cohort Study

Hypothermic machine perfusion attenuates DCD liver ischemia reperfusion injury via the YAP1/P53-mediated micromitophagy pathway.

Donor Age- and BMI-Related Outcomes in Heart Donation After Circulatory Death (DCD)

Using Hypothermic, Oxygenated Perfusion (HOPE) to Extend Out-of-Body Times for Cardiac Grafts in a Porcine Model of Donation After Circulatory Death (DCD)

Impact of Donor Age on Outcomes After Donation After Circulatory Death (DCD) Heart Transplantation

10 °C Lung Preservation in Donation After Brain Death and Donation After Circulatory Death: Comparable Clinical Outcomes and Improved Logistics

Intermediate-Term Clinical Outcomes Following Donation After Circulatory Death with On-Table Reanimation