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Updated: Nov 19, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Cardiac Graft Assessment in the Era of Machine Perfusion: Current and Future Biomarkers
Martina Bona1,2, Rahel K Wyss1,2, Maria Arnold1,2
1Department of Cardiovascular Surgery InselspitalBern University Hospital Bern Switzerland.
Insights
Biomarkers can improve heart transplant success by assessing graft quality, especially for extended-criteria or circulatory death donors. This enhances organ availability and patient outcomes.
Area of Science:
- Cardiology
- Transplantation Immunology
- Biomarker Discovery
Background:
- Heart transplantation is the gold standard for end-stage heart failure, but donor organ shortage persists.
- Extended-criteria and donation after circulatory death donors increase organ availability but require optimized protocols to mitigate injury.
- Cardiac ex situ machine perfusion offers a platform for improved graft assessment and preservation.
Purpose of the Study:
- To review current knowledge on biomarkers for cardiac graft evaluation.
- To enhance precision and reliability in identifying suitable hearts for transplantation.
- To support the safe increase of donor heart availability.
Main Methods:
- Categorization of potential biomarkers into functional, metabolic, hormone/prohormone, cellular damage/death, and inflammatory markers.
- Synthesis of existing literature on biomarker utility in cardiac graft assessment.
- Analysis of how biomarkers can inform clinical protocols for heart transplantation.
Main Results:
- Several promising biomarkers show potential for assessing cardiac graft viability.
- Biomarkers can aid in evaluating hearts from extended-criteria and donation after circulatory death donors.
- Ex situ machine perfusion facilitates sensitive monitoring of graft quality using these biomarkers.
Conclusions:
- Biomarker evaluation is crucial for optimizing heart transplantation protocols.
- Improved graft assessment through biomarkers can increase the safe utilization of donor hearts.
- Further research and integration of biomarkers can enhance precision in donor heart selection.
Abstract:
Heart transplantation remains the treatment of reference for patients experiencing end-stage heart failure; unfortunately, graft availability through conventional donation after brain death is insufficient to meet the demand. Use of extended-criteria donors or donation after circulatory death has emerged to increase organ availability; however, clinical protocols require optimization to limit or prevent damage in hearts possessing greater susceptibility to injury than conventional grafts. The emergence of cardiac ex situ machine perfusion not only facilitates the use of extended-criteria donor and donation after circulatory death hearts through the avoidance of potentially damaging ischemia during graft storage and transport, it also opens the door to multiple opportunities for more sensitive monitoring of graft quality. With this review, we aim to bring together the current knowledge of biomarkers that hold particular promise for cardiac graft evaluation to improve precision and reliability in the identification of hearts for transplantation, thereby facilitating the safe increase in graft availability. Information about the utility of potential biomarkers was categorized into 5 themes: (1) functional, (2) metabolic, (3) hormone/prohormone, (4) cellular damage/death, and (5) inflammatory markers. Several promising biomarkers are identified, and recommendations for potential improvements to current clinical protocols are provided.
