Metabolic Considerations in Direct Procurement and Perfusion Protocols with DCD Heart Transplantation

Area of Science:

• Cardiology
• Transplantation Medicine
• Metabolic Research

Background:

• Donation after circulatory death (DCD) heart transplantation offers improved donor heart availability and patient outcomes.
• DCD grafts experience warm, unprotected ischemia and a pre-ischemic phase after withdrawal of life-sustaining therapy (WLST), unlike brain-dead donor grafts.
• These conditions can negatively impact cardiac energy metabolism and graft quality.

Purpose of the Study:

• To review metabolic changes in DCD donor hearts during WLST, circulatory arrest, and warm ischemia.
• To elucidate the role of altered energy substrate availability in graft quality and post-ischemic recovery.
• To inform clinical protocols and pre-clinical models for DCD heart transplantation.

Main Methods:

• Literature review focusing on metabolic, hemodynamic, and biochemical changes in DCD donors.
• Analysis of cardiac energy metabolism regulation during pre-procurement phases.
• Synthesis of information on cellular damage and reperfusion effects.

Main Results:

• DCD donors exhibit acute metabolic and hemodynamic shifts, including high catecholamines, hypoxia, and warm ischemia.
• These changes induce metabolic alterations and cellular damage, further exacerbated by reperfusion.
• Altered energy substrate availability before organ procurement significantly impacts graft quality and recovery.

Conclusions:

• Understanding metabolic changes during WLST and ischemia is vital for optimizing DCD heart graft quality.
• Clinical and pre-clinical strategies should consider these metabolic alterations.
• Focusing on initial reperfusion conditions and graft evaluation is key to tailoring therapies for optimal transplantation outcomes.