Superior cardiac protection in combined ex-situ perfusion of heart and liver.

BACKGROUND

Normothermic ex-situ heart perfusion has helped expand the heart donor pool however, it is not optimized yet. Experimental ex-situ organ perfusion incorporating cross-circulation with a live animal has achieved significantly longer safe ex-situ preservation times; however, the underlying mechanisms are not clear.

METHODS

In this study, combined ex-situ heart-liver perfusion of porcine hearts was compared to ex-situ isolated heart perfusion. Discarded human donor hearts were also perfused ex-situ and cardiac function and metabolism was studied.

RESULTS

The hearts perfused together with liver were preserved significantly better, with lower edema, preserved key nutrients, and lower oxidative stress, (comparable to in vivo samples). Human donor hearts subjected to ex-situ perfusion had similar function and oxidative patterns compared to isolated porcine hearts, suggesting these hearts are vulnerable to the same phenomena as porcine hearts.

CONCLUSIONS

Our findings suggest that efficient antioxidant and energy metabolite support is necessary for improving the functional preservation of the donor heart during ex-situ perfusion.