title: Hypothermic continuous machine perfusion enables preservation of energy charge and functional recovery of heart grafts in an ex vivo model of donation following circulatory death.
abstract: OBJECTIVE
  Cardiac transplantation using hearts from donors after circulatory death (DCD) is critically limited by the unavoidable warm ischaemia and its related unpredictable graft function. Inasmuch as hypothermic machine perfusion (MP) has been shown to improve heart preservation, we hypothesized that MP could enable the use of DCD hearts for transplantation.
  
  
  METHODS
  We recovered 16 pig hearts following anoxia-induced cardiac arrest and cardioplegia. Grafts were randomly assigned to two different groups of 4-h preservation using either static cold storage (CS) or MP (Modified LifePort© System, Organ Recovery Systems©, Itasca, Il). After preservation, the grafts were reperfused ex vivo using the Langendorff method for 60 min. Energetic charge was quantified at baseline, post-preservation and post-reperfusion by measuring lactate and high-energy phosphate levels. Left ventricular contractility parameters were assessed both in vivo prior to ischaemia and ex vivo during reperfusion.
  
  
  RESULTS
  Following preservation, the hearts that were preserved using CS exhibited higher lactate levels (57.1 ± 23.7 vs 21.4 ± 12.2 µmol/g; P < 0.001), increased adenosine monophosphate/adenosine triphosphate ratio (0.53 ± 0.25 vs 0.11 ± 0.11; P < 0.001) and lower phosphocreatine/creatine ratio (9.7 ± 5.3 vs 25.2 ± 11; P < 0.001) in comparison with the MP hearts. Coronary flow was similar in both groups during reperfusion (107 ± 9 vs 125 ± 9 ml/100 g/min heart; P = ns). Contractility decreased in the CS group, yet remained well preserved in the MP group.
  
  
  CONCLUSIONS
  MP preservation of DCD hearts results in improved preservation of the energy and improved functional recovery of heart grafts compared with CS.
authors.affiliation: Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium olivier.vancaenegem@uclouvain.be.
authors.forename: Olivier
authors.initials: O
authors.lastname: Van Caenegem
authors.affiliation: Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium Division of Cardiology, Cliniques universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Beauloye
authors.affiliation: Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Bertrand
authors.affiliation: Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Horman
authors.affiliation: Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lepropre
authors.affiliation: Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Grégory
authors.initials: G
authors.lastname: Sparavier
authors.affiliation: Organ Recovery Systems©, Zaventem, Belgium.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Vercruysse
authors.affiliation: Division of Cardiac Surgery, Cliniques universitaires Saint Luc, Brussels, Belgium.
authors.forename: Noëlla
authors.initials: N
authors.lastname: Bethuyne
authors.affiliation: Division of Cardiac Surgery, Cliniques universitaires Saint Luc, Brussels, Belgium Pôle de chirurgie expérimentale et transplantation, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Alain J
authors.initials: AJ
authors.lastname: Poncelet
authors.affiliation: Pôle de chirurgie expérimentale et transplantation, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Gianello
authors.affiliation: Organ Recovery Systems©, Zaventem, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Demuylder
authors.affiliation: Pôle de chirurgie expérimentale et transplantation, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Legrand
authors.affiliation: Pôle de chirurgie expérimentale et transplantation, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Gwen
authors.initials: G
authors.lastname: Beaurin
authors.affiliation: Pôle de biochimie et recherche métabolique, Institut de Duve, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Françoise
authors.initials: F
authors.lastname: Bontemps
authors.affiliation: Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium.
authors.forename: Luc M
authors.initials: LM
authors.lastname: Jacquet
authors.affiliation: Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Division of Cardiology, Cliniques universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
mesh_terms: D000818:Animals; D006321:Heart / Q000502:physiology*; D016027:Heart Transplantation; D007036:Hypothermia, Induced / Q000379:methods / Q000706:statistics & numerical data; D008955:Models, Cardiovascular; D015425:Myocardial Reperfusion / Q000379:methods / Q000706:statistics & numerical data; D012769:Shock; D013552:Swine; D014019:Tissue Donors; D014021:Tissue Preservation / Q000379:methods* / Q000706:statistics & numerical data*; D019737:Transplants / Q000502:physiology*
keywords: Donation after circulatory death; Heart transplantation; Machine perfusion