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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...

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Autores principales: Ughetto, Aurore, Roubille, François, Molina, Adrien, Battistella, Pascal, Gaudard, Philippe, Demaria, Roland, Guihaire, Julien, Lacampagne, Alain, Delmas, Clément
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657826/
https://www.ncbi.nlm.nih.gov/pubmed/38028479
http://dx.doi.org/10.3389/fcvm.2023.1248606
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author Ughetto, Aurore
Roubille, François
Molina, Adrien
Battistella, Pascal
Gaudard, Philippe
Demaria, Roland
Guihaire, Julien
Lacampagne, Alain
Delmas, Clément
author_facet Ughetto, Aurore
Roubille, François
Molina, Adrien
Battistella, Pascal
Gaudard, Philippe
Demaria, Roland
Guihaire, Julien
Lacampagne, Alain
Delmas, Clément
author_sort Ughetto, Aurore
collection PubMed
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.
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spelling pubmed-106578262023-01-01 Heart graft preservation technics and limits: an update and perspectives Ughetto, Aurore Roubille, François Molina, Adrien Battistella, Pascal Gaudard, Philippe Demaria, Roland Guihaire, Julien Lacampagne, Alain Delmas, Clément Front Cardiovasc Med Cardiovascular Medicine 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. Frontiers Media S.A. 2023-11-06 /pmc/articles/PMC10657826/ /pubmed/38028479 http://dx.doi.org/10.3389/fcvm.2023.1248606 Text en © 2023 Ughetto, Roubille, Molina, Battistella, Gaudard, Demaria, Guihaire, Lacampagne and Delmas. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Ughetto, Aurore
Roubille, François
Molina, Adrien
Battistella, Pascal
Gaudard, Philippe
Demaria, Roland
Guihaire, Julien
Lacampagne, Alain
Delmas, Clément
Heart graft preservation technics and limits: an update and perspectives
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 Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657826/
https://www.ncbi.nlm.nih.gov/pubmed/38028479
http://dx.doi.org/10.3389/fcvm.2023.1248606
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