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Myocardial microcirculation combined with lactate measurements predicts ventricular contractility in a canine DCD orthotopic heart transplantation during ex situ machine perfusion

Background.  - Strictly trusting lactate to classify a donation after circulatory death (DCD) heart as transplantable or not during ex vivo blood perfusion (EVBP) has been criticized. Here, we verified novel prediction parameters based on myocardial microcirculation, which we had developed in prev...

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Autori principali: Saemann, Lars (Autore) , Ferencz, Robert (Autore) , Benke, Kálmán (Autore) , Veres, Gábor (Autore) , Willsch, Jan (Autore) , Große, Marco (Autore) , Spornhauer, Andreas (Autore) , Stiller, Markus (Autore) , Bálint, Tímea (Autore) , Damenija, Givi Jr (Autore) , Barta, Bálint András (Autore) , Spiesshofer, Sylvia (Autore) , Stengl, Roland (Autore) , Csonka, Máté (Autore) , Simm, Andreas (Autore) , Radovits, Tamás (Autore) , Szabó, Gábor (Autore)
Natura: Article (Journal)
Lingua:inglese
Pubblicazione: May 2026
In: Transplantation
Year: 2026, Volume: 110, Fascicolo: 5, Pages: 1-5
ISSN:1534-6080
DOI:10.1097/TP.0000000000005665
Accesso online:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/TP.0000000000005665
Verlag, lizenzpflichtig, Volltext: https://journals.lww.com/transplantjournal/fulltext/2026/05000/myocardial_microcirculation_combined_with_lactate.20.aspx
Testo
Note sull'autore:Lars Saemann, PhD, Robert Ferencz, Kálmán Benke, MD, PhD, Gábor Veres, MD, PhD, Jan Willsch, ECCP, Marco Große, ECCP, Andreas Spornhauer, ECCP, Markus Stiller, ECCP, Tímea Bálint, Givi Damenija, Jr, Bálint András Barta, PhD, Sylvia Spiesshofer, Roland Stengl, PhD, Máté Csonka, PhD, Andreas Simm, PhD, Tamás Radovits, PhD, and Gábor Szabó, MD, PhD
Descrizione
Riassunto:Background.  - Strictly trusting lactate to classify a donation after circulatory death (DCD) heart as transplantable or not during ex vivo blood perfusion (EVBP) has been criticized. Here, we verified novel prediction parameters based on myocardial microcirculation, which we had developed in previous porcine Langendorff experiments, in canine orthotopic heart transplantation (HTx) with DCD. - Methods.  - The hearts (n = 7) were maintained by EVBP. We measured lactate, monitored the myocardial microcirculation in the left-ventricular (LV) anterior wall during EVBP, using a laser Doppler perfusion (LDP) needle probe, and developed a prediction model based on LDP shifts and venous lactate during EVBP. The hearts were transplanted, and the LV-end-systolic pressure volume relationship (ESPVR) was determined. Considering that reaching at least 80% of the donor-LV-ESPVR is acceptable to maintain circulation in the recipient, we also calculated sensitivity and Specificity of the model to predict that 80% of the donor-LV-ESPVR will be reached after HTx. - Results.  - The combination of the LDP shift and venous lactate in a linear model showed the highest r (0.950) and r2 (0.902) for LV-ESPVR and thus served best for a prediction model. The respective, exemplary formula to predict that at least 80% of the donor-LV-ESPVR will be reached after HTx showed a sensitivity of 100% and a specificity of 83.3%. - Conclusions.  - We conclude that the LV-ESPVR after orthotopic HTx with DCD seems to be predictable by combining the microcirculatory parameter First-to-Lastinterval shift during, and the Lacven at the end of EVBP in a linear model.
Descrizione del documento:Gesehen am 09.06.2026
Descrizione fisica:Online Resource
ISSN:1534-6080
DOI:10.1097/TP.0000000000005665

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