BACKGROUND There has been an increased interest in donation after circulatory death (DCD) to expand donor pool for cardiac transplantation. Normothermic regional perfusion (NRP) allows in situ assessment of DCD hearts, allowing only acceptable organs to be procured. We sought to determine if extended cold storage was possible for DCD hearts following NRP and to compare hearts stored using standard cold storage with a novel cardioprotective solution designed for room temperature storage. METHODS AND RESULTS Donor pigs underwent hypoxic cardiac arrest (DCD) followed by 15 minutes of warm ischemia and resuscitation on NRP. They were then randomly assigned to static storage with histidine-tryptophan-ketoglutarate (HTK) at 4°C (HTK group, n=5) or SOM-TRN-001 at 21°C (SOM group, n=5). Conventional beating-heart donations were used as controls (n=4). Fourteen transplants were successfully performed. HTK hearts showed initial dysfunction following reperfusion; however, they demonstrated significant recovery up to 3 hours post-transplant. No significant differences were seen between HTK and control hearts post-transplantation (cardiac index: control 49.5±6% and HTK 48.5±5% of baseline). SOM improved myocardial preservation; hearts showed stable contractility after transplantation (cardiac index: 113.0±43% of NRP function) and improved diastolic function compared with HTK. Preservation in SOM also significantly reduced proinflammatory cytokine production and release following transplantation and partially prevented endothelial dysfunction. CONCLUSIONS DCD hearts stored using a standard preservation solution demonstrated comparable post-transplantation myocardial function to standard controls. Thus, short periods of cold storage following successful NRP and documented adequate function is an acceptable strategy for DCD hearts. Preservation in SOM at room temperature is feasible and can improve cardiac recovery by minimizing endothelial dysfunction and tissue injury.

中文翻译：

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循环死亡后捐赠的心脏和使用常温区域灌注进行修复的心脏可以在延长的静态储存时间后成功移植。

背景技术对循环死亡后的捐赠（DCD）的兴趣日益增加，以扩大用于心脏移植的捐赠者库。正常体温区域灌注（NRP）可以对DCD心脏进行原位评估，仅允许接受可接受的器官。我们试图确定在NRP之后，DCD心脏是否可以进行延长的冷藏，并将标准冷藏与用于室温存放的新型心脏保护溶液进行比较。方法和结果供体猪进行了缺氧性心脏骤停（DCD），随后进行了15分钟的热缺血并在NRP上复苏。然后将它们随机分配到在4°C下使用组氨酸-色氨酸-酮戊二酸（HTK）静态存储（HTK组，n = 5）或在21°C下使用SOM-TRN-001（SOM组，n = 5）。常规的跳动心脏捐赠被用作对照（n = 4）。成功进行了十四次移植。HTK心脏在再灌注后显示出最初的功能障碍；然而，它们在移植后3小时内显示出明显的恢复。移植后HTK与对照心脏之间无明显差异（心脏指数：基线的对照为49.5±6％，HTK为基线的48.5±5％）。SOM改善了心肌的保存；与HTK相比，心脏移植后显示出稳定的收缩力（心脏指数：NRP功能的113.0±43％），舒张功能得到改善。SOM中的保存还可以显着减少移植后促炎细胞因子的产生和释放，并部分预防内皮功能障碍。结论使用标准保存液保存的DCD心脏表现出与标准对照相当的移植后心肌功能。因此，成功的NRP和记录的适当功能后短期冷藏是DCD心脏可接受的策略。在室温下保存SOM是可行的，并且可以通过最小化内皮功能障碍和组织损伤来改善心脏恢复。