Heart Transplantation From Brain Dead Donors: A Systematic Review of Animal Models
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Wells, Matthew A
Bartnikowski, Nicole
Obonyo, Nchafatso G
Millar, Jonathan E
Khoo, Aimee
Ki, Katrina K
Shuker, Tristan
Ferraioli, Alessandro
Colombo, Sebastiano M
Chan, Wandy
McGiffin, David C
Suen, Jacky Y
Fraser, John F
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Abstract
Despite advances in mechanical circulatory devices and pharmacological therapies, heart transplantation is the definitive and most effective therapy for an important proportion of qualifying patients with end-stage heart failure. However, the demand for donor hearts significantly outweighs the supply. Hearts are sourced from donors following brain death, which exposes donor hearts to substantial pathophysiological perturbations that can influence heart transplant success and recipient survival. While significant advances in recipient selection, donor and HTx recipient management, immunosuppression and pretransplant mechanical circulatory support have been achieved, primary graft dysfunction after cardiac transplantation continues to be an important cause of morbidity and mortality.Animal models, when appropriate, can guide/inform medical practice, and fill gaps in knowledge that are unattainable in clinical settings. Consequently, we performed a systematic review of existing animal models that incorporate donor brain death and subsequent heart transplantation, and assessed studies for scientific rigor and clinical relevance. Following literature screening via MEDLINE and Embase, 29 studies were assessed. Analysis of included studies identified marked heterogeneity in animal models of donor brain death coupled to heart transplantation, with few research groups worldwide identified as utilizing these models. General reporting of important determinants of heart transplant success was mixed, and assessment of posttransplant cardiac function was limited to an invasive technique (pressure-volume analysis), which is limitedly applied in clinical settings.This review highlights translational challenges between available animal models and clinical heart transplant settings that is potentially hindering advancement of this field of investigation.
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Transplantation
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104
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11
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See Hoe, LE; Wells, MA; Bartnikowski, N; Obonyo, NG; Millar, JE; Khoo, A; Ki, KK; Shuker, T; Ferraioli, A; Colombo, SM; Chan, W; McGiffin, DC; Suen, JY; Fraser, JF, Heart Transplantation From Brain Dead Donors: A Systematic Review of Animal Models., Transplantation, 2020, 104 (11), pp.2272-2289