Ex-vivo Perfusion Research Articles

A proof-of-principle for decontamination of transplantation kidney through UV-C exposition of the perfusate solution

Kidney transplantation is a common yet highly demanding medical procedure worldwide, enhancing the quality of life for patients with chronic kidney disease. Despite its prevalence, the procedure faces a shortage of available organs, partly due to contamination by microorganisms, leading to significant organ disposal. This study proposes utilizing photonic techniques associated with organ support machines to prevent patient contamination during kidney transplantation. We implemented a decontamination system using ultraviolet-C (UV-C) irradiation on the preservation solution circulating through pigs' kidneys between harvest and implant. UV-C irradiation, alone or combined with ultrasound (US) and Ps80 detergent during ex-vivo swine organ perfusion in a Lifeport® Kidney Transporter machine, aimed to reduce microbiological load in both fluid and organ. Results show rapid fluid decontamination compared to microorganism release from the organ, with notable retention. By including Ps80 detergent at 0.5% during UV-C irradiation 3 log10 (CFU mL−1) of Staphylococcus aureus bacteria previously retained in the organ were successfully removed, indicating the technique's feasibility and effectiveness.

Comprehensive bile acid pool analysis during ex-vivo liver perfusion in a porcine model of ischemia-reperfusion injury

Bile acids (BA) are key for liver regeneration and injury. This study aims at analyzing the changes in the BA pool induced by ischemia-reperfusion (IRI) and investigates the impact of hypothermic oxygenated perfusion (HOPE) on the BA pool compared to static cold storage (SCS). In a porcine model of IRI, liver grafts underwent 30 min of asystolic warm ischemia followed by 6 h of SCS (n = 6) ± 2 h of HOPE (n = 6) and 2 h of ex-situ warm reperfusion. The BA pool in bile samples was analyzed with liquid chromatography coupled with tandem mass spectrometry. We identified 16 BA and observed significant changes in response to ischemia-reperfusion, which were associated with both protective and injury mechanisms. Second, HOPE-treated liver grafts exhibited a more protective BA phenotype, characterized by a more hydrophilic BA pool compared to SCS. Key BA, such as GlycoCholic Acid, were identified and were associated with a decreased transaminase release and improved lactate clearance during reperfusion. Partial Least Square-Discriminant Analysis revealed a distinct injury profile for the HOPE group. In conclusion, the BA pool changes with liver graft IRI, and preservation with HOPE results in a protective BA phenotype compared to SCS.

Development of a novel ex-vivo human liver segmental perfusion model for translational pre-clinical research: human liver response to pneumococcal infection at the organ level

Development of a novel ex-vivo human liver segmental perfusion model for translational pre-clinical research: human liver response to pneumococcal infection at the organ level

Beating Heart Transplants—Overview and Implications for Anesthesiologists

As the demand of heart allografts for transplantation continues to rise, ex-vivo organ perfusion strategies are playing an increasingly important role in preservation of organs from donation after circulatory death (DCD) and extended-criteria donors. One such method utilizes the Organ Care System™ (TransMedics, Andover, MA). Traditionally, this technique of preservation requires two periods of warm ischemia and subsequent cardioplegic arrest. In a novel surgical technique pioneered at our institution, heart allograft implantation no longer requires a second cardioplegic arrest. This article discusses the surgical approach for this procedure, advantages and disadvantages to this approach, and analogues to current clinical practice to theorize what impact this may have on cardiac transplantation volumes in the future.

The role of oxygenation in kidney and liver machine perfusion

Background. Organ transplantation is the optimal decision for patients in the end stage of many diseases. Certain conditions are required for the transportation and preservation of a donor organ after explantation, including factors such as temperature, pressure, and preservative solution. All currently available methods of preservation of donor organs are aimed at maximizing the complete preservation of the functional state of the graft from the moment of its removal to implantation and reperfusion in the recipient's body.Aim. The purpose of this review is to provide up-to-date information on the results of the studies performed in order to decide on the preferred method of organ preservation.Material and methods. An analysis of literature sources in English and Russian from 2009 to 2023 on this topic was performed in the databases PubMed, MEDLINE, Google Scholar. The review highlights the results of preclinical (on animal models) and clinical studies, as well as achievements in the field of ex-vivo machine perfusion with an emphasis on machine hypothermic perfusion and modified oxygenated hypothermic machine perfusion, subnormothermic machine perfusion and machine normothermic perfusion.Results. The daily increase in the number of patients in need of organ transplantation delays the timely selection and search for a donor. Organ donation after cardiac death is a promising step in an attempt to overcome the disbalance between the number of patients and organs, but the risk of developing early graft damage increases. The criteria for selecting donors and donor organs are being expanded, as a result, elderly donors and not-optimal grafts are included, but they are less resistant to ischemic damage. In this connection, there is a need for long-term infusion support through machine perfusion.Conclusion. In recent years, research has focused on alternative preservation methods, studying hypothermic, subnormothermic and normothermic machine perfusion. The use of machine perfusion has become the most widespread among kidney transplants and has shown good results. Further development is expected in the field of studying and improving this method of organ preservation, which allows not only transporting, but also improving the functional state of the graft.

Review of machine perfusion studies in vascularized composite allotransplant preservation.

The applications of Vascularized composite allotransplantation (VCA) are increasing since the first successful hand transplantation in 1998. However, the abundance of muscle tissue makes VCA's vulnerable to ischemia-reperfusion injury (IRI), which has detrimental effects on the outcome of the procedure, restricting allowable donor-to-recipient time and limiting its widespread use. The current clinical method is Static cold storage (SCS) and this allows only 6 h before irreversible damage occurs upon reperfusion. In order to overcome this obstacle, the focus of research has been shifted towards the prospect of ex-vivo perfusion preservation which already has an established clinical role in solid organ transplants especially in the last decade. In this comprehensive qualitative review, we compile the literature on all VCA machine perfusion models and we aim to highlight the essentials of an ex vivo perfusion set-up, the different strategies, and their associated outcomes.

HPB O04 Segmental perfusion of ex-vivo human liver segments: A 3Rs compliant directly translatable model for pharmacological, bacteriological and genetic research

Abstract Background We have previously presented studies describing the development of a human ex-vivo segmental liver perfusion model (AUGIS 2022, Plenary Prize Session). Utilising surgically resected human liver segments which would otherwise be discarded, bacteriological studies examining host-pathogen interactions can be assessed in a controlled experimental setting. The aim of this study was to compare in a human model the conclusions of work published in the Journal of Experimental Medicine which suggested that in a murine model high-virulence serotypes of Streptococcus pneumoniae exhibited an extraordinary ability to evade capture by Kupffer cells (An et al., 2022). Methods Suitable patients undergoing elective liver resections at a single hepato-pancreato-biliary unit were recruited to the TIMOLD trial. Following hemi-hepatectomies, a healthy liver segment was resected from the specimen and flushed with one litre of heparinised CustodiolTM HTK solution on ice. A segmental branch of the hepatic artery (HA) and portal vein (PV) was identified and cannulated. Ten human liver segments were subjected to normothermic machine perfusion for six hours with OxyglobinTM. During perfusion, six segments were infected with different strains and serotypes of Streptococcus pneumoniae. Perfusate and biopsy specimen were analysed to evaluate bacterial clearance and co-localisation with Kupffer cells. Results Human liver segments exhibited normal histology during perfusion for both control and infected liver segments. Although infected segments had a longer warm and cold ischaemia time than controls (p=0.03 and p=0.01, respectively), there was no difference in PV or HA resistance. Furthermore, there was no difference in lactate clearance (p=0.55), glucose regulation (p=0.87), or potassium clearance (p=0.47). Perfusate culture assays demonstrated no bacterial elimination by the liver. Furthermore, immunofluorescent staining of Kupffer cells and bacteria found no co-localisation of high and low virulence serotypes to hepatic macrophages after 30 minutes (p=0.52) and five hours (p=0.14) of infection. Conclusions Human liver segments did not eliminate pneumococcal strains in a serotype-specific manner or demonstrate preferential co-localisation of bacteria with macrophages based on serotype. These findings highlight issues when extrapolating findings from small animal models as demonstrated with the response of the human liver to invading pathogens. The adoption and implementation of an ex-vivo human liver segmental perfusion model entirely eliminates the need for unethical and unnecessary animal experiments. Using perfused ex-vivo human liver from surgically resected specimens provides a metabolically and physiologically stable environment and is unique in providing results which can be directly translated to the clinical setting.

Renal cortex microperfusion evaluated by laser speckle contrast imaging in an exvivo perfused kidney model-A proof-of-concept study.

Validated quantitative biomarkers for assessment of renal graft function during normothermic machine perfusion (NMP) conditions are lacking. The aim of this project was to quantify cortex microperfusion during exvivo kidney perfusion using laser speckle contrast imaging (LSCI), and to evaluate the sensitivity of LSCI when measuring different levels of renal perfusion. Furthermore, we aimed to introduce LSCI measurements during NMP in differentially damaged kidneys. Eleven porcine kidneys were nephrectomized and perfused exvivo. Cortex microperfusion was simultaneously monitored using LSCI. First, a flow experiment examined the relationship between changes in delivered renal flow and corresponding changes in LSCI-derived cortex microperfusion. Second, renal cortical perfusion was reduced stepwise by introducing a microembolization model. Finally, LSCI was applied for measuring renal cortex microperfusion in kidneys exposed to minimal damage or 2 h warm ischemia (WI). Cortex microperfusion was calculated from the LSCI-obtained data. The flow experiment resulted in relatively minor changes in cortex microperfusion compared to the pump-induced changes in total renal flow. Based on stepwise injections of microspheres, we observed different levels of cortex microperfusion that correlated with administrated microsphere dosages (r2 = 0.95-0.99). We found no difference in LSCI measured cortex microperfusion between the kidneys exposed to minimal damage (renal cortex blood flow index, rcBFI = 2090-2600) and 2 h WI (rcBFI = 2189-2540). Based on this preliminary study, we demonstrated the feasibility of LSCI in quantifying cortex microperfusion during exvivo perfusion. Furthermore, based on LSCI-measurements, cortical microperfusion was similar in kidneys exposed to minimal and 2 h WI.

The effects of inflammation and acidosis on placental blood vessels reactivity

IntroductionInflammation and acidosis are two stress stimuli that correspond to pathophysiological processes occurring in placental-mediated vascular disorders. We aimed to investigate the effects of these stimuli on placental chorionic blood vessels reactivity using the ex-vivo placental perfusion model. MethodsTerm placentas were obtained immediately after cesarean deliveries, and selected cotyledons were cannulated and dually perfused ex-vivo. Placentas were perfused with three different protocols: culture medium (M199-controls, n = 5), culture medium with lipopolysaccharide (inflammatory stimuli) (LPS,1 μg/ml, n = 7), and acidotic culture medium (M − 199, pH: 6.9–7, n = 6). Each perfusion experiment was maintained for 180 min. Fetal perfusion pressure was continuously measured. Measurements in response to angiotensin II (AT II) at the end of the perfusion were compared between the treatment groups, including amplitude of the contraction response, relaxation factor, time to maximal constriction and the area under the pressure curve (AUC). ResultsIn response to ATII there was a significant difference in the amplitude of the contraction and the AUC between the treatment groups, (p = 0.049, p = 0.015, respectively). As compared with control perfused cotyledon, the inflammatory stimuli significantly increased the vasoconstriction response to ATII in fetal placental blood vessels, as expressed by increased AUC - median (IQR): 555 (235–1184) vs. 133 (118–207), respectively, p = 0.017. The time to maximal constriction and the relaxation factor did not differ between the groups. DiscussionInflammatory stimuli but not acidosis impact fetal-placental vasculature in response to ATII, suggesting that inflammation can compromise vascular function.

Placental disposition of cannabidiol: An exvivo perfusion study.

In the absence of safety data in humans, the use of cannabidiol (CBD) is not recommended during pregnancy. Yet >50% of pregnancies in women with epilepsy are unintended, making fetal exposure to CBD possible. As a small-molecule, highly lipid-soluble drug, CBD is likely to be distributed into the placenta and cross it. To estimate the placental distribution profile of CBD and its potential short-term placental effects, we conducted an exvivo perfusion study in human placentas. Placentas were obtained from healthy women undergoing cesarean deliveries. Selected cotyledons were cannulated and perfused for 180 min with a CBD-containing medium (250 ng/mL, .796 μmol·L-1 ; representative of a low therapeutic concentration; n = 8). CBD concentrations were determined at 180 min in the medium and placental tissue using liquid chromatography-tandem mass spectrometry. A customized gene panel array was used to analyze the expression of selected genes in the perfused placental cotyledons as well as in placentas perfused with 1000 ng/mL CBD (3.18 μmol·L-1 ; high therapeutic concentration; n = 8) and in those exposed to the vehicle. CBD was sequestered in the placental tissue, exhibiting significant variability across samples (median = 5342 ng/g tissue, range = 1066-9351 ng/g tissue). CBD concentrations in the fetal compartment were one fifth of those measured in the maternal compartment (median = 59 ng/mL, range = 48-72 ng/mL vs. 280 = ng/mL, range = 159-388 ng/mL, respectively; p < .01). Placental gene expression was not significantly altered by CBD. The placenta acts as a depot compartment for CBD, slowing down its distribution to the fetus. This phenomenon might yield flatter but prolonged fetal CBD levels invivo. The attenuated transplacental CBD transfer does not imply that its use by pregnant women is safe for the fetus. Only pregnancy registries and neurocognitive assessments would establish the risk of being antenatally exposed to CBD.

Ex-vivo human placental perfusion as a model for evaluating placental transfer of PETN to prevent intrauterine growth restriction

Ex-vivo human placental perfusion as a model for evaluating placental transfer of PETN to prevent intrauterine growth restriction

SP3.6 Does a novel preservation solution improve organ performance in an ex-vivo perfusion of porcine liver?

Abstract Aims This project aims to compare LS-A (Leeds solution for abdomen) to a gold standard solution, IGL-1 (Institute George-Lopez solution) at clinically acceptable CIT (Cold ischaemic time) in a DCD (Donation after cardiac death) model of porcine liver transplant. An ex-vivo Perfusion device will then provide normothermic machine perfusion to simulate the immediate post-transplant stage. Methods DCD livers retrieved from landrace pigs, were preserved at 4-hours CIT in LS-A or IGL-1. They were re-perfused on a normothermic machine perfusion device, using autologous blood as a perfusate. Biochemical analysis was performed hourly for various markers of tissue and hepatocyte damage. Results Livers stored in LS-A (n=6) and IGL-1 (n=6) have no significant differences when compared for ALT, AST, ALP, LDH and glucose. Perfusate lactate was significantly lower in the LS-A group (p=0.008) as was the perfusate potassium(p=0.001) across the perfusion period. Conclusions Analysis has shown significantly lower lactate and potassium in LS-A preserved livers, in DCD retrieval, with 4-hours CIT. There are no other observed significant differences between LS-A and IGL-1 when comparing liver function tests and LDH production. This suggests better tissue preservation with LS-A in the setting of very high risk donor livers. The next stage of the project will look at LS-A vs IGL-1 in an extended preservation period (&amp;gt;14 hours) in a DBD (Donation after brainstem death) model.

Heart Transplantation in High-Risk Recipients Employing Donor Marginal Grafts Preserved With Ex-Vivo Perfusion.

Extending selection criteria to face donor organ shortage in heart transplantation (HTx) may increase the risk of mortality. Ex-vivo normothermic perfusion (EVP) limits ischemic time allowing assessment of graft function. We investigated the outcome of HTx in 80 high-risk recipients transplanted with marginal donor and EVP-preserved grafts, from 2016 to 2021. The recipients median age was 57years (range, 13-75), with chronic renal failure in 61%, impaired liver function in 11% and previous cardiac surgery in 90%; 80% were mechanically supported. Median RADIAL score was 3. Mean graft ischemic time was 118 ± 25min, "out-of-body" time 420 ± 66min and median cardiopulmonary bypass (CPB) time 228min (126-416). In-hospital mortality was 11% and ≥moderate primary graft dysfunction 16%. At univariable analysis, CPB time and high central venous pressure were risk factors for mortality. Actuarial survival at 1 and 3years was 83% ± 4%, and 72% ± 7%, with a median follow-up of 16months (range 2-43). Recipient and donor ages, pre-HTx extracorporeal life support and intra-aortic balloon pump were risk factors for late mortality. In conclusion, the use of EVP allows extension of the graft pool by recruitment of marginal donors to successfully perform HTx even in high-risk recipients.

Increased human complement pathway regulatory protein gene dose is associated with increased endothelial expression and prolonged survival during ex-vivo perfusion of GTKO pig lungs with human blood.

Expression of human complement pathway regulatory proteins (hCPRP's) such as CD46 or CD55 has been associated with improved survival of pig organ xenografts in multiple different models. Here we evaluate the hypothesis that an increased human CD46 gene dose, through homozygosity or additional expression of a second hCPRP, is associated with increased protein expression and with improved protection from injury when GTKO lung xenografts are perfused with human blood. Twenty three GTKO lungs heterozygous for human CD46 (GTKO.heteroCD46), 10 lungs homozygous for hCD46 (GTKO.homoCD46), and six GTKO.homoCD46 lungs also heterozygous for hCD55 (GTKO.homoCD46.hCD55) were perfused with human blood for up to 4h in an ex vivo circuit. Relative to GTKO.heteroCD46 (152min, range 5-240; 6/23 surviving at 4h), survival was significantly improved for GTKO.homoCD46 (>240min, range 45-240, p=.034; 7/10 surviving at 4h) or GTKO.homoCD46.hCD55 lungs (>240min, p=.001; 6/6 surviving at 4h). Homozygosity was associated with increased capillary expression of hCD46 (p<.0001). Increased hCD46 expression was associated with significantly prolonged lung survival (p=.048),) but surprisingly not with reduction in measured complement factor C3a. Hematocrit, monocyte count, and pulmonary vascular resistance were not significantly altered in association with increased hCD46 gene dose or protein expression. Genetic engineering approaches designed to augment hCPRP activity - increasing the expression of hCD46 through homozygosity or co-expressing hCD55 with hCD46 - were associated with prolonged GTKO lung xenograft survival. Increased expression of hCD46 was associated with reduced coagulation cascade activation, but did not further reduce complement activation relative to lungs with relatively low CD46 expression. We conclude that coagulation pathway dysregulation contributes to injury in GTKO pig lung xenografts perfused with human blood, and that the survival advantage for lungs with increased hCPRP expression is likely attributable to improved endothelial thromboregulation.

Jacketed elastomeric tubes for passive self-regulation of pulsatile flow

Regulating pulsatile flow is important to achieve optimal separation and mixing and enhanced heat transfer in microfluidic devices, as well as maintaining homeostasis in biological systems. The human aorta, a composite and layered tube made (among others) of elastin and collagen, is an inspiration for researchers who seek an engineering solution for a self-regulation of pulsatile flow. Here, we present a bio-inspired approach showing that fabric-jacketed elastomeric tubes, manufactured using commercially available silicone rubber and knitted textiles, can be used to regulate pulsatile flow. Our tubes are evaluated via incorporation into a mock-circulatory ‘flow loop’ that replicates the pulsatile fluid flow conditions of an ex-vivo heart perfusion (EVHP) device, a machine used in heart transplants. Pressure waveforms measured near the elastomeric tubing clearly indicated an effective flow regulation. The ‘dynamic stiffening’ behavior of the tubes during deformation is analyzed quantitatively. Broadly, the fabric jackets allow for the tubes to experience greater magnitudes of pressure and distension without risk of asymmetric aneurysm within the expected operating time of an EVHP. Owing to its highly tunable nature, our design may serve as a basis for tubing systems that require passive self-regulation of pulsatile flow.

Oxygen carriers affect kidney immunogenicity during ex-vivo machine perfusion.

Normothermic ex-vivo machine perfusion provides a powerful tool to improve donor kidney preservation and a route for the delivery of pharmacological or gene therapeutic interventions prior to transplantation. However, perfusion at normothermic temperatures requires adequate tissue oxygenation to meet the physiological metabolic demand. For this purpose, the addition of appropriate oxygen carriers (OCs) to the perfusion solution is essential to ensure a sufficient oxygen supply and reduce the risk for tissue injury due to hypoxia. It is crucial that the selected OCs preserve the integrity and low immunogenicity of the graft. In this study, the effect of two OCs on the organ's integrity and immunogenicity was evaluated. Porcine kidneys were perfused ex-vivo for four hours using perfusion solutions supplemented with red blood cells (RBCs) as conventional OC, perfluorocarbon (PFC)-based OC, or Hemarina-M101 (M101), a lugworm hemoglobin-based OC named HEMO2life®, recently approved in Europe (i.e., CE obtained in October 2022). Perfusions with all OCs led to decreased lactate levels. Additionally, none of the OCs negatively affected renal morphology as determined by histological analyses. Remarkably, all OCs improved the perfusion solution by reducing the expression of pro-inflammatory mediators (IL-6, IL-8, TNFα) and adhesion molecules (ICAM-1) on both transcript and protein level, suggesting a beneficial effect of the OCs in maintaining the low immunogenicity of the graft. Thus, PFC-based OCs and M101 may constitute a promising alternative to RBCs during normothermic ex-vivo kidney perfusion.

Biocompatibility of the oxygen carrier polymerized human hemoglobin towards HepG2/C3A cells

Hemoglobin (Hb) based oxygen carriers (HBOCs) are designed to minimize the toxicity of extracellular Hb, while preserving its high oxygen-carrying capacity for oxygen delivery to cells. Polymerized human Hb (PolyHb) is a novel type of nanosized HBOC synthesized via glutaraldehyde-mediated crosslinking of free Hb, and which preserves the predominant quaternary state during the crosslinking reaction (low oxygen affinity tense (T) quaternary state PolyHb is synthesized at 0% Hb oxygen saturation, and high oxygen affinity relaxed (R) quaternary state PolyHb is synthesized at 100% Hb oxygen saturation). Major potential applications for PolyHbs, and HBOCs in general, include oxygenation of bioreactor systems containing large liver cell masses, and ex-vivo perfusion preservation of explanted liver grafts. The toxicity of these compounds toward liver cells must be evaluated before testing their use in these complex systems for oxygen delivery. Herein, we characterized the effect of PolyHbs on the hepatoma cell line HepG2/C3A, used as a model hepatocyte and as a cell line used in some investigational bioartificial liver support devices. HepG2/C3A cells were incubated in cell culture media containing PolyHbs or unmodified Hb at concentrations up to 50 mg/mL and for up to 6 days. PolyHbs were well tolerated at a dose of 10 mg/mL, with no significant decrease in cell viability; however, proliferation was inhibited as much as 10-fold after 6 days of exposure at 50 mg/mL. Secretion of albumin, and urea, as well as glucose and ammonia removal were measured in presence of 10 mg/mL of PolyHbs or unmodified Hb. In addition, methoxy- and ethoxy-resorufin deacetylase (MROD and EROD) activities, which reflect cytochrome P450 metabolism, were measured. R-state PolyHb displayed improved or intact activity in 3 out of 7 functions compared to unmodified Hb. T-state PolyHb displayed improved or intact activity in 4 out of 7 functions compared to unmodified Hb. Thus, PolyHbs, both in the R-state and T-state, are safer to use at a concentration of 10 mg/mL as compared to unmodified Hb in static culture liver-related applications.

Abstract 470: Targeting The Local Inflammation In Atherosclerosis Using An Ex-vivo Perfusion System Of Human Coronary Arteries

Atherosclerosis is characterized by the accumulation of lipids, immune cells, and fibrotic tissue in the arterial intima. Although well described as an inflammatory condition, targeting the inflammation component of atherosclerosis while avoiding systemic toxicity remains a clinical challenge. Pro-inflammatory cytokines such as IL-1β and IL-6 have been implicated in atherosclerotic plaque progression and atherothrombotic events. Recent clinical trials have shown promising results targeting these cytokines to reduce the risk of adverse cardiac events in patients, yet systemic toxicity remains a concern. We hypothesize that knocking down the local inflammation using siRNA against IL-1β and/or IL-6 may be a viable therapeutic strategy to treat atherosclerosis. To test our hypothesis, we used an ex-vivo perfusion system of human coronary arteries (hCA) collected from non-transplantable, de-identified hearts ( Fig. A ). Hearts came from donors with or without cardiovascular disease (CVD) risk factors including hypertension, high cholesterol, and diabetes mellitus. hCA isolated from donors with CVD risk factors showed increased IL-1β ( Fig. B ) and IL-6 ( Fig. C ) expression levels assessed by RT-qPCR, compared to controls without risk factors. Perfusion of hCA with media containing TNF-α and IFN-γ increased the expression of both IL-1β and IL-6 ( Fig. D ). Thus, the perfusion system established here will allow us to assess the efficacy of delivering IL-1β and/or IL-6 specific siRNA complexed nanoparticles and will advance the development of novel nanotherapies that target inflammation in atherosclerosis.

(867) Functional Assessment During Unloaded, Ex-Vivo Perfusion Could Help Predict Recovery in Cardiac Dcd Grafts: Studies in a Porcine Model

(867) Functional Assessment During Unloaded, Ex-Vivo Perfusion Could Help Predict Recovery in Cardiac Dcd Grafts: Studies in a Porcine Model

(245) Proteins Released During Ex-Vivo Perfusion are Promising Biomarkers for Cardiac Graft Quality: Studies in an Isolated Rat Heart Model of DCD

(245) Proteins Released During Ex-Vivo Perfusion are Promising Biomarkers for Cardiac Graft Quality: Studies in an Isolated Rat Heart Model of DCD