Beating Heart – HIV-to-HIV Heart – Partial Heart
By Luc Puis
Let’s talk transplantation today. Last Thursday, September 29, was International Heart Day, so let’s take heart. Three remarkable, first in-heart transplantations happened, extending life and expanding the donor pool.
On the China Circuit
A team in China performed the first ischaemic-free, beating heart transplantation in a human. By combining adapted surgical techniques and normothermic machine perfusion (NMP), the team was able to keep the heart beating during procurement, transport, and implantation in the recipient. The donor’s heart was procured after an in situ NMP circuit was established, then underwent ex-situ NMP and was implanted under NMP support. With this technique, cold, ischaemic preservation is completely eradicated, and ischemia-reperfusion injury is avoided.
While this first procedure was performed in the same hospital and with minimal transport needed , the IFBHT technique showed feasibility in that it potentially will increase graft availability and improve transplant outcomes in the near future.
Heartbeat Bronx
Meanwhile, in the Bronx, NY, the transplant team of Montefiore Health System performed the world’s first HIV-positive to HIV-positive heart transplant. The patient received the HIV-positive heart simultaneously with a kidney transplant earlier this year.
It was in 2013 that the HIV Organ Policy Equity Act enabled people living with HIV to donate their organs to an HIV-positive recipient. It has taken almost ten years for heart transplantation to be realized. This is possible thanks to recent medical advances that allow HIV-positive people to control their disease so they can save the lives of others. This will surely enable us to expand the much-needed organ donor pool to people who had nowhere to go earlier.
Duke Did What?
And to wrap it up with more positive news, Duke Health performed an innovative living tissue partial heart transplant. A baby born with truncus arteriosus needed a heart transplant. Since the waiting list for newborns is more than six months and not having that time for him, doctors and family decided to use partial tissue and valves from a donor heart that had good valves, but not strong enough muscle tissue. This enabled the otherwise rejected heart to be used for its’ useful parts to be implanted into this newborn.
The surgery was successful, and the valves and tissue are growing together, along with the thriving baby, who returned home safely and is developing normally.
This truly simple yet innovative technique will allow expansion of the donor pool and help newborns not only with truncus arteriosus but also with other congenital cardiac malformations to avoid transplants or successive interventions to replace not growing tissue.
Three positive, hope-giving stories to celebrate International World Heart Day.
Sources
World Heart Day: https://world-heart-federation.org/world-heart-day/about-whd/
Yin S, Rong J, Chen Y ,et al. Transplantation of a beating heart: A first in man. Lancet Reg Health West Pac. 2022; 23: 100449 https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(22)00064-5/fulltext#%20
No Author Listed (2022) World’s First HIV-Positive to HIV-Positive Heart Transplant Performed at Montefiore Health System – Montefiore News Releases https://www.montefiore.org/body.cfm?id=1738&action=detail&ref=2194
Lopez s. (2022) Duke Health Performs World’s First Partial Heart Transplant – Duke Health News https://today.duke.edu/2022/09/duke-health-performs-world%E2%80%99s-first-partial-heart-transplant
