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Use of extended\u2010criteria donors or donation after circulatory death has emerged to increase organ availability; however, clinical protocols require optimization to limit or prevent damage in hearts possessing greater susceptibility to injury than conventional grafts. The emergence of cardiac ex situ machine perfusion not only facilitates the use of extended\u2010criteria donor and donation after circulatory death hearts through the avoidance of potentially damaging ischemia during graft storage and transport, it also opens the door to multiple opportunities for more sensitive monitoring of graft quality. With this review, we aim to bring together the current knowledge of biomarkers that hold particular promise for cardiac graft evaluation to improve precision and reliability in the identification of hearts for transplantation, thereby facilitating the safe increase in graft availability. Information about the utility of potential biomarkers was categorized into 5 themes: (1) functional, (2) metabolic, (3) hormone\/prohormone, (4) cellular damage\/death, and (5) inflammatory markers. Several promising biomarkers are identified, and recommendations for potential improvements to current clinical protocols are provided.<\/jats:p>","DOI":"10.1161\/jaha.120.018966","type":"journal-article","created":{"date-parts":[[2021,1,30]],"date-time":"2021-01-30T05:21:17Z","timestamp":1611984077000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":49,"title":["Cardiac Graft Assessment in the Era of Machine Perfusion: Current and Future Biomarkers"],"prefix":"10.1161","volume":"10","author":[{"given":"Martina","family":"Bona","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery InselspitalBern University Hospital Bern Switzerland"},{"name":"Department for BioMedical Research University of Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahel K.","family":"Wyss","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery InselspitalBern University Hospital Bern Switzerland"},{"name":"Department for BioMedical Research University of Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery InselspitalBern University Hospital Bern Switzerland"},{"name":"Department for BioMedical Research University of Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"M\u00e9ndez\u2010Carmona","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery InselspitalBern University Hospital Bern Switzerland"},{"name":"Department for BioMedical Research University of Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria N.","family":"Sanz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery InselspitalBern University Hospital Bern Switzerland"},{"name":"Department for BioMedical Research University of Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4127-4086","authenticated-orcid":false,"given":"Dominik P.","family":"Guensch","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine\/Institute for Diagnostic, Interventional and Paediatric Radiology Bern University HospitalInselspitalUniversity of Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5827-0439","authenticated-orcid":false,"given":"Lucio","family":"Barile","sequence":"additional","affiliation":[{"name":"Laboratory for Cardiovascular Theranostics Cardiocentro Ticino Foundation and Faculty of Biomedical Sciences Universit\u00e0 Svizzera Italiana Lugano Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7881-6822","authenticated-orcid":false,"given":"Thierry P.","family":"Carrel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery InselspitalBern University Hospital Bern Switzerland"},{"name":"Department for BioMedical Research University of Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8489-917X","authenticated-orcid":false,"given":"Sarah L.","family":"Longnus","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery InselspitalBern University Hospital Bern Switzerland"},{"name":"Department for BioMedical Research University of Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","unstructured":"Branger P Samuel U. 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