Ex Vivo Therapeutics in Cardiac Xenotransplantation: A Scoping Review

Genetically modified porcine hearts through xenotransplantation offer a promising solution for the current donor scarcity from human allotransplantation. Machine perfusion has successfully been used for graft preservation in two landmark in-human cardiac xenotransplantation cases using hypothermic oxygenated perfusion. Alternate machine perfusion approaches, including normothermic perfusion on a "beating heart" device such as the Transmedics Organ Care System (OCS), have not been fully evaluated. Although preclinical studies have shown that continuous machine perfusion enhances graft viability and function in pig-to-primate cardiac xenotransplantation models, therapeutic questions and challenges remain. We performed a scoping review to assess the current literature and outstanding areas of investigation regarding machine perfusion of cardiac xenografts focusing on the potential for ex vivo therapeutics in this field.