title: Cardiac transplantation with hearts from donors after circulatory declaration of death: haemodynamic and biochemical parameters at procurement predict recovery following cardioplegic storage in a rat model.
abstract: OBJECTIVE
  Donation after circulatory declaration of death (DCDD) could significantly improve the number of cardiac grafts for transplantation. Graft evaluation is particularly important in the setting of DCDD given that conditions of cardio-circulatory arrest and warm ischaemia differ, leading to variable tissue injury. The aim of this study was to identify, at the time of heart procurement, means to predict contractile recovery following cardioplegic storage and reperfusion using an isolated rat heart model. Identification of reliable approaches to evaluate cardiac grafts is key in the development of protocols for heart transplantation with DCDD.
  
  
  METHODS
  Hearts isolated from anaesthetized male Wistar rats (n = 34) were exposed to various perfusion protocols. To simulate DCDD conditions, rats were exsanguinated and maintained at 37°C for 15-25 min (warm ischaemia). Isolated hearts were perfused with modified Krebs-Henseleit buffer for 10 min (unloaded), arrested with cardioplegia, stored for 3 h at 4°C and then reperfused for 120 min (unloaded for 60 min, then loaded for 60 min). Left ventricular (LV) function was assessed using an intraventricular micro-tip pressure catheter. Statistical significance was determined using the non-parametric Spearman rho correlation analysis.
  
  
  RESULTS
  After 120 min of reperfusion, recovery of LV work measured as developed pressure (DP)-heart rate (HR) product ranged from 0 to 15 ± 6.1 mmHg beats min(-1) 10(-3) following warm ischaemia of 15-25 min. Several haemodynamic parameters measured during early, unloaded perfusion at the time of heart procurement, including HR and the peak systolic pressure-HR product, correlated significantly with contractile recovery after cardioplegic storage and 120 min of reperfusion (P < 0.001). Coronary flow, oxygen consumption and lactate dehydrogenase release also correlated significantly with contractile recovery following cardioplegic storage and 120 min of reperfusion (P < 0.05).
  
  
  CONCLUSIONS
  Haemodynamic and biochemical parameters measured at the time of organ procurement could serve as predictive indicators of contractile recovery. We believe that evaluation of graft suitability is feasible prior to transplantation with DCDD, and may, consequently, increase donor heart availability.
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
authors.forename: Joevin
authors.initials: J
authors.lastname: Sourdon
authors.forename: Monika
authors.initials: M
authors.lastname: Dornbierer
authors.forename: Simon
authors.initials: S
authors.lastname: Huber
authors.forename: Brigitta
authors.initials: B
authors.lastname: Gahl
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
authors.forename: Hendrik T
authors.initials: HT
authors.lastname: Tevaearai
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Longnus
mesh_terms: D000818:Animals; D002314:Cardioplegic Solutions; D016027:Heart Transplantation; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D015424:Reperfusion; D018709:Statistics, Nonparametric; D019737:Transplants / Q000737:chemistry / Q000502:physiology / Q000592:standards; D016896:Treatment Outcome
chemical_list: D002314:Cardioplegic Solutions
keywords: Cardiac graft evaluation; Donation after cardiac death; Donation after circulatory declaration of death; Heart transplantation; Ischaemia-reperfusion; Isolated rat heart; Non-heart beating donors