1. Cardiac Graft Assessment in the Era of Machine Perfusion: Current and Future Biomarkers
- Author
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Sarah L. Longnus, Thierry Carrel, Natalia Méndez-Carmona, Dominik Günsch, Maria Arnold, Maria N. Sanz, Lucio Barile, Martina Bona, and Rahel K. Wyss
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,610 Medicine & health ,donation after circulatory death ,030204 cardiovascular system & hematology ,030230 surgery ,heart transplantation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Diseases of the circulatory (Cardiovascular) system ,extended‐criteria heart donors ,Intensive care medicine ,Heart transplantation ,Machine perfusion ,business.industry ,biomarkers ,ex situ heart perfusion ,medicine.disease ,Circulatory death ,Transplantation ,Heart failure ,Potential biomarkers ,Donation ,RC666-701 ,Cardiology and Cardiovascular Medicine ,business - Abstract
Heart transplantation remains the treatment of reference for patients experiencing end‐stage heart failure; unfortunately, graft availability through conventional donation after brain death is insufficient to meet the demand. Use of extended‐criteria donors or donation after circulatory death has emerged to increase organ availability; however, clinical protocols require optimization to limit or prevent damage in hearts possessing greater susceptibility to injury than conventional grafts. The emergence of cardiac ex situ machine perfusion not only facilitates the use of extended‐criteria donor and donation after circulatory death hearts through the avoidance of potentially damaging ischemia during graft storage and transport, it also opens the door to multiple opportunities for more sensitive monitoring of graft quality. With this review, we aim to bring together the current knowledge of biomarkers that hold particular promise for cardiac graft evaluation to improve precision and reliability in the identification of hearts for transplantation, thereby facilitating the safe increase in graft availability. Information about the utility of potential biomarkers was categorized into 5 themes: (1) functional, (2) metabolic, (3) hormone/prohormone, (4) cellular damage/death, and (5) inflammatory markers. Several promising biomarkers are identified, and recommendations for potential improvements to current clinical protocols are provided. more...
- Published
- 2021
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