Publication: Critical warm ischemia time point for cardiac donation after circulatory death
Authors
Sanchez Camara, Silvia ; Asensio Lopez, Maria del Carmen ; Royo Villanova, Mario ; Soler, Fernando ; Jara Rubio, Ruben ; Garrido Peñalver, Jose F ; Pinar, Eduardo ; Hernandez Vicente, Alvaro ; Hurtado, Jose A ; Lax Pérez, Antonio Manuel ; Pascual Figal, Domingo A.
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DOI
10.1111/ajt.16987
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info:eu-repo/semantics/article
Description
©2022. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
This document is the Published, version of a Published Work that appeared in final form in American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the
American Society of Transplant Surgeons. To access the final edited and published work see https://doi.org/10.1111/ajt.16987
Abstract
Donation after circulatory death (DCD) represents a promising opportunity to overcome the relative shortage of donors for heart transplantation. However, the necessary period of warm ischemia is a concern. This study aims to determine the critical
warm ischemia time based on in vivo biochemical changes. Sixteen DCD non-cardiac
donors, without cardiovascular disease, underwent serial endomyocardial biopsies
immediately before withdrawal of life-sustaining therapy (WLST), at circulatory arrest
(CA) and every 2 min thereafter. Samples were processed into representative pools to
assess calcium homeostasis, mitochondrial function and cellular viability. Compared
to baseline, no significant deterioration was observed in any studied parameter at the
time of CA (median: 9 min; IQR: 7–13 min; range: 4–19 min). Ten min after CA, phosphorylation of cAMP-dependent protein kinase-A on Thr197 and SERCA2 decreased
markedly; and parallelly, mitochondrial complex II and IV activities decreased, and
caspase 3/7 activity raised significantly. These results did not differ when donors with
higher WLST to CA times (≥9 min) were analyzed separately. In human cardiomyocytes, the period from WLST to CA and the first 10 min after CA were not associated
with a significant compromise in cellular function or viability. These findings may help
to incorporate DCD into heart transplant programs.
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Citation
American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons
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