CardiacTransplantation

Key Research Areas

• Donor management
• Ischemia reperfusion injury
• Heart failure
• Heart transplantation
• Pulmonary hypertension

Research Overview

Professor Peter Macdonald and his team are leading a new era in heart transplantation, responsible for the most significant advance in this field in the last three decades.

The Cardiac Transplantation Laboratory focuses on the most effective treatment for patients with advanced heart disease and end-stage heart failure. For these patients, their condition has become so severe that transplantation is the only option. Around 100 heart transplants are performed every year in Australia. Transplantation is currently limited to only a small percentage of people, due to the scarcity of suitable donor organs. The Victor Chang Cardiac Research Institute is working on novel methods of donor management and donor heart preservation using the Heart-in-a-Box technology, with the hope of extending this life-saving treatment to a larger number of Australians.

There are 2 key projects underway in the Cardiac Transplantation Laboratory, led by Professor Peter Macdonald:

1. DCD

In a world first, doctors at St Vincent’s Hospital have managed to transplant a heart that had stopped beating (Donation after Circulation Death). The heart was brought back to life, and then placed on a machine, before it was injected with a unique preservation solution – developed by Professor Peter Macdonald and his team. The unique preservation solution and the portable machine extend the amount of time a donor heart can spend in transit from 4 to as many as 14 hours. Thanks to this breakthrough, Prof Peter Macdonald and his team anticipate that an extra 30 transplants will be performed per year in Australia and many more around the world. Which means more lives will be saved, and more families spared the burden of caring for a severely ill relative. Since 2014, 74 heart transplants using DCD donor hearts have been performed. Patient outcomes are similar to those receiving hearts from traditional brain dead donors.

2. Frailty and advanced heart failure

Frailty is prevalent amongst patients with advanced symptomatic heart failure. Regardless of age or gender, these patients are at higher risk of responding poorly to a major stress such as a heart transplant or a mechanical heart implantation. Since 2013, the Macdonald Laboratory has been assessing both physical and psychosocial frailty in all patients referred for heart transplant. The team has discovered that frailty is a very powerful independent predictor of mortality in patients with advanced heart failure. They are continuing to try and identify biomarkers that distinguish between reversible and irreversible frailty, in an effort to improve prognosis following heart transplantation.

1. Yashutosh Joshi, Sarah Scheuer, Hong Chew, Min Ru Qiu, Claudio Soto, Jeanette Villanueva, Ling Gao, Aoife Doyle, Charles Jenkinson, Nikunj Vaidhya , Shingo Takahara, Bridget Hwang, Christine Zhao, Arjun Iyer, Mark Connellan, Alasdair Watson, Emily Granger, Paul Jansz, Peter S Macdonald. Heart Transplantation from DCD donors in Australia: lessons learned from the first 74 cases (2022). Transplantation. Submitted.
2. MA. Redd, SE. Scheuer, NJ. Saez, L.Gao, M. Hicks, JE. Villanueva, ME. Reichelt, JN. Peart, LE. See Hoe, HS. Chiu, X. Chen, ND. Condon, Y. Sun, JY. Suen, S. Maljevic, WG. Thomas, Gabriel Cuellar-Partida, JF. Fraser, S. Petrou, GF. King, PS. Macdonald & NJ. Palpant (2021) Therapeutic inhibition of acid sensing ion channel 1a recovers heart function after ischemia-reperfusion injury. Circulation. 2021 Sep;144:947-960.
3. Kumud Dhital, Arjun Iyer, Mark Connellan, Hong Chee Chew, Ling Gao, Aoife Doyle, Mark Hicks, Claude Soto, Andrew Dinale, Bruce Cartwright, Priya Nair, Emily Granger, Paul Jansz, Andrew Jabbour, Eugene Kotlyer, Anne Keogh, Christopher Hayward, Robert Graham, Phillip Spratt and Peter Macdonald (2015). Adult heart transplantation with distant procurement and ex-vivo preservation of donor hearts after circulatory death: a case series. Lancet; Published online April 15, 2015.
4. McDonagh, Julee and Martin, Lily and Ferguson, Caleb and Jha, Sunita R and Macdonald, Peter S and Davidson, Patricia M and Newton, Phillip J (2017)Frailty assessment instruments in heart failure: A systematic review. European Journal of Cardiovascular Nursing, ePub. p. 1474515117708888. ISSN 1873-1953 (Not OA) Item not available from this repository.
5. Mauthner, Oliver and Claes, Veerle and Deschodt, Mieke and Jha, Sunita R and Engberg, Sandra and Macdonald, Peter S and Newton, Phillip J and De Geest, Sabina (2017) Handle with care: A systematic review on frailty in cardiac care and its usefulness in heart transplantation. Transplantation Reviews, ePub. ISSN 1557-9816 (Not OA) Item not available from this repository.
6. Jha, Sunita R and Mcdonagh, Julee and Ferguson, Caleb and Macdonald, Peter S and Newton, Phillip J (2017) Commentary response: Frailty, not just about old people: Reply to Smith GD & Kydd A (2017) Getting care of older people right: the need for appropriate frailty assessment? Journal of Clinical Nursing, ePub. ISSN 1365-2702 (Not OA) Item not available from this repository.
7. Ferguson, Caleb and Inglis, Sally C and Newton, Phillip J and Middleton, Sandy and Macdonald, Peter S and Davidson, Patricia M (2017) Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: patient and provider perspectives. Journal of Clinical Nursing, ePub. ISSN 1365-2702 (Not OA) Item not available from this repository.
8. Jha, Sunita R and Hannu, Malin K and Gore, Keren and Chang, Sungwon and Newton, Phillip and Wilhelm, Kay and Hayward, Christopher S and Jabbour, Andrew and Kotlyar, Eugene and Keogh, Anne and Dhital, Kumud and Granger, Emily and Jansz, Paul and Spratt, Phillip M and Montgomery, Elyn and Harkess, Michelle and Tunicliff, Peta and Davidson, Patricia M and Macdonald, Peter S (2016) Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation. The Journal of Heart and Lung Transplantation, 35 (9). pp.1092-1100. ISSN 1557-3117 (Not OA) Item not available from this repository.
9. Ferguson, Caleb and Inglis, Sally C and Newton, Phillip J and Middleton, Sandy and Macdonald, Peter S and Davidson, Patricia M (2016) Multi-morbidity, frailty and self-care: important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study. European Journal of Cardiovascular Nursing. pp.1-12. ISSN 1873-1953 (Not OA) Item not available from this repository.
10. Jha, Sunita R and Hannu, Malin K and Chang, Sungwon and Montgomery, Elyn and Harkess, Michelle and Wilhelm, Kay and Hayward, Christopher S and Jabbour, Andrew and Spratt, Phillip M and Newton, Phillip and Davidson, Patricia M and Macdonald, Peter S (2016) The Prevalence and Prognostic Significance of Frailty in Patients With Advanced Heart Failure Referred for Heart Transplantation. Transplantation, 100 (2). pp.429-36. ISSN 1534-6080 (OA) Item not available from this repository.
11. Ferguson, Caleb and Inglis, Sally C and Newton, Phillip J and Middleton, Sandy and Macdonald, Peter S and Davidson, Patricia M (2016) Education and practice gaps on atrial fibrillation and anticoagulation: a survey of cardiovascular nurses. BMC Medical Education, 16 (1). p. 9. ISSN 1472-6920 (OA)
12. Iyer, Arjun and Chew, Hong Chee and Gao, Ling and Villanueva, Jeanette and Hicks, Mark and Doyle, Aoife and Kumarasinghe, Gayathri and Jabbour, Andrew and Jansz, Paul Cassius and Feneley, Michael P and Harvey, Richard P and Graham, Robert M and Dhital, Kumud K and Macdonald, Peter S (2016) Pathophysiological Trends During Withdrawal of Life Support: Implications for Organ Donation After Circulatory Death. Transplantation, 100 (12). pp.2621-2629. ISSN 1534-6080 (Not OA) Item not available from this repository.
13. Cao, Yiming and Shahrestani, Sara and Chew, Hong Chee and Crawford, Michael and Macdonald, Peter S and Laurence, Jerome and Hawthorne, Wayne John and Dhital, Kumud and Pleass, Henry (2016) Donation After Circulatory Death for Liver Transplantation: A Meta-Analysis on the Location of Life Support Withdrawal Affecting Outcomes. Transplantation, 100 (7). pp.1513-1524. ISSN 1534-6080 (Not OA) Item not available from this repository.
14. Jha, Sunita R and Ha, Hakeem S K and Hickman, Louise D and Hannu, Malin and Davidson, Patricia M and Macdonald, Peter S and Newton, Phillip J(2015) Frailty in advanced heart failure: a systematic review. Heart Failure Reviews, 20 (5). pp.553-60. ISSN 1573-7322 (Not OA) Item not available from this repository.
15. Iyer, Arjun and Gao, Ling and Doyle, Aoife and Rao, Padmashree and Cropper, J R and Soto, C and Dinale, Andrew and Kumarasinghe, Gayathri and Jabbour, Andrew and Hicks, Mark and Jansz, Paul and Feneley, Michael P and Harvey, Richard P and Graham, Robert M and Dhital, Kumud and Macdonald, Peter S (2015)Normothermic ex vivo perfusion provides superior organ preservation and enables viability assessment of hearts from DCD donors. American Journal of Transplantation, 15 (2). pp.371-80. ISSN 1600-6143 (OA) Item not available from this repository.
16. Iyer, Arjun and Gao, Ling and Doyle, Aoife and Rao, Padmashree and Jayewardene, D and Wan, B and Kumarasinghe, Gayathri and Jabbour, Andrew and Hicks, Mark and Jansz, Paul and Feneley, Michael P and Harvey, Richard P and Graham, Robert M and Dhital, Kumud and Macdonald, Peter S (2014) Increasing the tolerance of DCD hearts to warm ischemia by pharmacological postconditioning. American Journal of Transplantation, 14 (8). pp.1744-52. ISSN 1600-6143 (OA) Item not available from this repository.
17. Macdonald PS, A systematic review and meta-analysis of clinical trials of thyroid hormone administration to brain dead potential organ donors. Crit Care Med 2012 [in press]
18. Hing A, Watson A, Hicks M, Gao L, Faddy SC, McMahon AC, Kesteven SH, Feneley MP, Wilson MK, Macdonald PS. Combining cariporide with glyceryl trinitrate optimises cardiac preservation during porcine heart transplantation. Am J Transplant 2009;9(9):2048-56
19. Jabbour A, Hayward CS, Keogh AM, Kotlyar E, McCrohan JA, England JF, Amor R, Liu X, Li X, Zhou M, Graham RM, Macdonald PS. Parenteral administration of recombinant human neuregulin-1 to patients with stable chronic heart failure produces favourable acute and chronic haemodynamic responses. Eur J Heart Failure 2011 Jan;13(1):83-92