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An Immunological Model for Heterotopic Heart and Cardiac Muscle Cell Transplantation in Rats
Published on: May 8, 2020
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Survival, function, and immune profiling after beating heart transplantation
Aravind Krishnan1, Stefan Elde1, Chawannuch Ruaengsri1
1Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
The Journal of Thoracic and Cardiovascular Surgery
|August 7, 2024
Summary
Beating heart transplantation using ex vivo heart perfusion (EVHP) offers excellent survival and low rejection rates for cardiac allografts. This technique avoids secondary cardioplegic arrest, reducing ischemia-reperfusion injury in heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Immunology
- Surgical Innovation
Background:
- Ex vivo normothermic perfusion (EVHP) has expanded the donor pool for heart transplantation.
- Beating heart implantation avoids secondary cardioplegic arrest and associated ischemia-reperfusion injury.
Purpose of the Study:
- To describe the institutional experience with beating heart transplantation.
- To evaluate outcomes including survival, need for mechanical support, and rejection rates.
Main Methods:
- Retrospective study of adult heart transplant patients using EVHP and beating heart implantation (October 2022 - March 2024).
- Comparison with a cohort of nonbeating deceased after circulatory death (DCD) heart transplantations.
- Primary outcomes: survival, mechanical circulatory support initiation, rejection (pathologic grade and cell-free DNA).
Main Results:
- 24 patients underwent beating heart transplantation; 21 (87.5%) received DCD hearts.
- 95.8% survival at a median follow-up of 192 days.
- No patients required mechanical support; 66.7% had grade 0 rejection.
- Significantly lower rate of mechanical support initiation compared to nonbeating DCD transplants (P < .005).
Conclusions:
- Beating heart implantation is a viable technique for EVHP of DCD and DBD hearts.
- This method is associated with excellent patient survival.
- Low rejection rates were observed, suggesting reduced immunogenicity or improved graft tolerance.
