Pre-Transplant Therapy in Experimental Heart Transplantation

Abstract

Heart transplantation is a life-saving procedure for patients with end-stage cardiac dysfunction. Currently one-year graft survival ranges between 77-88%, three-year survival between 77-79% and five-year survival between 67-73% (http://www.americanheart.org/presenter.jhtml?identifier=4588). Despite these encouraging results, primary graft failure accounts for about 23% of deaths in the first 90 days post transplantation. Pretransplant variables associated with primary graft failure include: ischemia time, donor gender, donor age, multiorgan donation, center volume, extracorporeal membrane oxygenation, mechanical circulatory support, etiology of heart failure, and reoperative heart transplantation (Russo et al., 2010). To target rejection of allografts, a variety of immunosuppressive protocols are used solely in the recipient who is the main focus of the therapy (The International Society of Heart and Lung Transplantation Guidelines for the Care of Heart Transplant Recipients Task Force 2: Immunosuppression and Rejection (Nov. 8, 2010)). Typically, neither donor nor grafts are specifically treated before or during organ harvesting except for the maintenance of circulatory and respiratory functions of the donor and irrigation of grafts with preservation solutions.