Transplant International ISSN 0934-0874
ORIGINAL ARTICLE
Hypothermic continuous machine perfusion improves metabolic preservation and functional recovery in heart grafts Olivier Van Caenegem,1 Christophe Beauloye,1 Jonathan Vercruysse,2 Sandrine Horman,1 Luc €lla Bethuyne,3 Alain J Poncelet,3 Pierre Gianello,3 Peter Demuylder,2 Eric Legrand,3 Bertrand,1 Noe Gwen Beaurin,3 Francßoise Bontemps,4 Luc M Jacquet1 and Jean-Louis Vanoverschelde1 ^le de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium 1 Po 2 Organ Recovery Systems©, Zaventem, Belgium ^le de Chirurgie Exp 3 Po erimentale et Transplantation, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium ^le de biochimie et recherche m 4 Po etabolique, Institut de Duve, Universite Catholique de Louvain, Brussels, Belgium
Keywords heart transplantation, hypothermic machine perfusion, organ preservation. Correspondence Olivier Van Caenegem MD, Transplantation Cardiaque, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Bruxelles, Belgium. Tel.: 00 32 2 764 27 14; fax: 00 32 2 764 27 77; e-mail: [email protected] Conflicts of interest J. Vercruysse and P. Demuylder are employees of Organ Recovery Systems©, and their technical support is acknowledged with gratitude. These latter authors had no input in the data analysis or report. O. Van Caenegem, C. Beauloye, S. Horman, L. Bertrand, N. Bethuyne, A. Poncelet, P. Gianello, F. Bontemps, and JL Vanovershelde have no financial ties to any commercial entity with an interest in the manuscript’s subject, nor have they any other conflicts of interest to disclose.
Summary The number of heart transplants is decreasing due to organ shortage, yet the donor pool could be enlarged by improving graft preservation. Hypothermic machine perfusion (MP) has been shown to improve kidney, liver, or lung graft preservation. Sixteen pig hearts were recovered following cardioplegia and randomized to two different groups of 4-hour preservation using either static cold storage (CS) or MP (Modified LifePort© System, Organ Recovery Systems©, Itasca, Il). The grafts then underwent reperfusion on a Langendorff for 60 min. Energetic metabolism was quantified at baseline, postpreservation, and postreperfusion by measuring lactate and high-energy phosphates. The contractility index (CI) was assessed both in vivo prior to cardioplegia and during reperfusion. Following reperfusion, the hearts preserved using CS exhibited higher lactate levels (56.63 23.57 vs. 11.25 3.92 lmol/g; P < 0.001), increased adenosine monophosphate/adenosine triphosphate (AMP/ATP) ratio (0.4 0.23 vs. 0.04 0.04; P < 0.001), and lower phosphocreatine/creatine (PCr/Cr) ratio (33.5 12.6 vs. 55.3 5.8; P
ORIGINAL ARTICLE
Hypothermic continuous machine perfusion improves metabolic preservation and functional recovery in heart grafts Olivier Van Caenegem,1 Christophe Beauloye,1 Jonathan Vercruysse,2 Sandrine Horman,1 Luc €lla Bethuyne,3 Alain J Poncelet,3 Pierre Gianello,3 Peter Demuylder,2 Eric Legrand,3 Bertrand,1 Noe Gwen Beaurin,3 Francßoise Bontemps,4 Luc M Jacquet1 and Jean-Louis Vanoverschelde1 ^le de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium 1 Po 2 Organ Recovery Systems©, Zaventem, Belgium ^le de Chirurgie Exp 3 Po erimentale et Transplantation, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium ^le de biochimie et recherche m 4 Po etabolique, Institut de Duve, Universite Catholique de Louvain, Brussels, Belgium
Keywords heart transplantation, hypothermic machine perfusion, organ preservation. Correspondence Olivier Van Caenegem MD, Transplantation Cardiaque, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Bruxelles, Belgium. Tel.: 00 32 2 764 27 14; fax: 00 32 2 764 27 77; e-mail: [email protected] Conflicts of interest J. Vercruysse and P. Demuylder are employees of Organ Recovery Systems©, and their technical support is acknowledged with gratitude. These latter authors had no input in the data analysis or report. O. Van Caenegem, C. Beauloye, S. Horman, L. Bertrand, N. Bethuyne, A. Poncelet, P. Gianello, F. Bontemps, and JL Vanovershelde have no financial ties to any commercial entity with an interest in the manuscript’s subject, nor have they any other conflicts of interest to disclose.
Summary The number of heart transplants is decreasing due to organ shortage, yet the donor pool could be enlarged by improving graft preservation. Hypothermic machine perfusion (MP) has been shown to improve kidney, liver, or lung graft preservation. Sixteen pig hearts were recovered following cardioplegia and randomized to two different groups of 4-hour preservation using either static cold storage (CS) or MP (Modified LifePort© System, Organ Recovery Systems©, Itasca, Il). The grafts then underwent reperfusion on a Langendorff for 60 min. Energetic metabolism was quantified at baseline, postpreservation, and postreperfusion by measuring lactate and high-energy phosphates. The contractility index (CI) was assessed both in vivo prior to cardioplegia and during reperfusion. Following reperfusion, the hearts preserved using CS exhibited higher lactate levels (56.63 23.57 vs. 11.25 3.92 lmol/g; P < 0.001), increased adenosine monophosphate/adenosine triphosphate (AMP/ATP) ratio (0.4 0.23 vs. 0.04 0.04; P < 0.001), and lower phosphocreatine/creatine (PCr/Cr) ratio (33.5 12.6 vs. 55.3 5.8; P
