Graft preservation in heart transplantation: current approaches

Area of Science:

• Cardiology
• Transplant Surgery
• Organ Preservation

Background:

• Heart transplantation (HTx) is the optimal treatment for end-stage heart failure.
• Aging HTx candidates and donor shortages necessitate improved organ preservation strategies.
• Extended donor criteria increase risks, highlighting the importance of organ preservation.

Purpose of the Study:

• To review and critically assess clinical data on donor heart preservation techniques for HTx.
• To compare traditional static cold storage (CS) with newer methods like controlled hypothermia and machine perfusion (MP).
• To evaluate the impact of preservation strategies on HTx outcomes.

Main Methods:

• Review of existing clinical data on donor heart preservation strategies.
• Comparison of static cold storage (CS), static controlled hypothermia, and machine perfusion (MP) systems (normothermic and hypothermic).
• Assessment of techniques based on preservation effectiveness, ischemic time reduction, and marginal graft evaluation.

Main Results:

• Static controlled hypothermia may offer better heart preservation than traditional ice storage by avoiding sub-zero temperatures.
• Machine perfusion (MP) reduces ischemic time, a key factor in HTx mortality.
• Normothermic MP allows evaluation of marginal donor grafts, potentially expanding the donor pool.

Conclusions:

• While newer techniques like controlled hypothermia and MP are increasingly used, their superiority over traditional static cold storage (CS) for heart transplantation remains debated.
• Further clinical data is needed to definitively establish the benefits of advanced donor heart preservation methods.
• Optimizing donor organ preservation is critical for improving heart transplantation outcomes in an aging recipient population and with limited donor availability.