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A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft

Michelle Mendiola Pla1, Amy Evans2, Franklin H. Lee3, Yuting Chiang1, Muath Bishawi1, Andrew Vekstein1, Lillian Kang1, Diego Zapata4, Ryan Gross3, Alexis Carnes2, Lynden E. Gault5, Julie A. Balko6, Desiree Bonadonna2, Sam Ho5, Paul Lezberg7, Benjamin S. Bryner1, Jacob N. Schroder1, Carmelo A. Milano1, Dawn E. Bowles3

Abstract

Cardiac transplantation is the gold standard treatment for end-stage heart failure. However, it remains limited by the number of available donor hearts and complications such as primary graft dysfunction and graft rejection. The recent clinical use of an ex vivo perfusion device in cardiac transplantation introduces a unique opportunity for treating cardiac allografts with therapeutic interventions to improve function and avoid deleterious recipient responses. Establishing a translational, large-animal model for therapeutic delivery to the entire allograft is essential for testing novel therapeutic approaches in cardiac transplantation. The porcine, heterotopic heart transplantation model in the intraabdominal position serves as an excellent model for assessing the effects of novel interventions and the immunopathology of graft rejection. This model additionally offers long-term survival for the pig, given that the graft is not required to maintain the recipient's circulation. The aim of this protocol is to provide a reproducible and robust approach for achieving ex vivo delivery of a therapeutic to the entire cardiac allograft prior to transplantation and provide technical details to perform a survival heterotopic transplant of the ex vivo perfused heart.

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