Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland.
Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
Interact Cardiovasc Thorac Surg. 2021 May 10;32(5):683-694. doi: 10.1093/icvts/ivaa333.
The use of 'extended criteria' donor hearts and reconditioned hearts from donation after circulatory death has corresponded with an increase in primary graft dysfunction, with ischaemia-reperfusion injury being a major contributing factor in its pathogenesis. Limiting ischaemia-reperfusion injury through optimising donor heart preservation may significantly improve outcomes. We sought to review the literature to evaluate the evidence for this.
A review of the published literature was performed to assess the potential impact of organ preservation optimisation on cardiac transplantation outcomes.
Ischaemia-reperfusion injury is a major factor in myocardial injury during transplantation with multiple potential therapeutic targets. Innate survival pathways have been identified, which can be mimicked with pharmacological conditioning. Although incompletely understood, discoveries in this domain have yielded extremely encouraging results with one of the most exciting prospects being the synergistic effect of selected agents. Ex situ heart perfusion is an additional promising adjunct.
Cardiac transplantation presents a unique opportunity to perfuse the whole heart before, or immediately after, the onset of ischaemia, thus maximising the potential for global cardioprotection while limiting possible systemic side effects. While clinical translation in the setting of myocardial infarction has often been disappointing, cardiac transplantation may afford the opportunity for cardioprotection to finally deliver on its preclinical promise.
使用“扩展标准”供体心脏和来自心跳停止后捐献的再处理心脏，与原发性移植物功能障碍的增加相对应，缺血再灌注损伤是其发病机制的主要因素。通过优化供体心脏保存来限制缺血再灌注损伤可能会显著改善结果。我们试图回顾文献来评估这方面的证据。
对已发表的文献进行了回顾，以评估器官保存优化对心脏移植结果的潜在影响。
缺血再灌注损伤是移植过程中心肌损伤的一个主要因素，有多个潜在的治疗靶点。已经确定了先天存活途径，可以用药理学处理来模拟。尽管尚未完全理解，但这一领域的发现带来了非常令人鼓舞的结果，其中最令人兴奋的前景之一是选择药物的协同作用。离体心脏灌注是另一种有前途的辅助方法。
心脏移植为在缺血发生之前或之后立即对整个心脏进行灌注提供了独特的机会，从而最大限度地提高了全局心脏保护的潜力，同时限制了可能的全身副作用。虽然在心肌梗死的背景下，临床转化常常令人失望，但心脏移植可能为心脏保护提供机会，最终实现其临床前的承诺。
