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Preservation solution in heart transplantation

  • P. Menasché
Part of the Transplantation and Clinical Immunology book series (TRAC, volume 30)

Abstract

Acute graft failure still accounts for approximately 20–30% of early deaths after heart transplantation [1, 2]. This complication is clearly multifactorial. Thus, some of these failures can be related to the status of the donor heart (unrecognized existence of parietal and/or coronary abnormalities, hemodynamic instability at the time of harvest). At the opposing end of the sequence of events that the graft must go through, implantation and early reperfusion are critical steps during which damage can be induced by suboptimal preservation techniques. Nevertheless, it is usually admitted that most of this damage occurs during the ex-vivo transportation period. Theoretically, this damage could be avoided by continuous perfusion of the graft with blood or oxygenated crystalloid solution. For practical reasons, however, these perfusion techniques have not gained clinical acceptance and static immersion in hypothermic media remains the cornerstone of organ preservation. Consequently, the following remarks will focus on the principles of formulation and clinical applications of these solutions designed for initial arrest and subsequent storage of donor hearts.

Keywords

Heart Transplantation Calcium Overload Organ Preservation Donor Heart Cardiac Allograft Vasculopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Bourge RC, Naftel DC, Costanzo-Nordin MR et al. Pretransplantation risk factors for death after heart transplantation: a multiinstitutional study. J. Heart Lung Transplant. 1993; 12: 549–562.PubMedGoogle Scholar
  2. 2.
    De Maria R, Minoli L, Parolini M et al. Prognostic determinants of six-month morbidity and mortality in heart transplant recipients. J. Heart Lung Transplant. 1996; 15: 124–135.Google Scholar
  3. 3.
    Menasché Ph, Hricak B, Pradier F et al. Efficacy of lactobionate-enriched cardioplegic solution in preserving compliance of cold-stored heart transplants. J. Heart Lung Transplant. 1993; 12: 1053–1061.PubMedGoogle Scholar
  4. 4.
    Hopkinson DN, Odom NJ, Bridgewater BJM, Hooper TL. Comparison of saccharides as osmotic impermeants during hypothermic lung graft preservation. Transplantation, 1996; 61: 1667–1671.PubMedCrossRefGoogle Scholar
  5. 5.
    Belzer FO, Southard JH. Principles of solid-organ preservation by cold storage. Transplantation. 1988; 45: 673–676.PubMedCrossRefGoogle Scholar
  6. 6.
    Drinkwater DC, Ziv ET, Laks H et al. Extracellular and standard University of Wisconsin solutions provide equivalent preservation of myocardial function. J. Thorac. Cardiovasc. Surg. 1995; 110: 738–745.PubMedCrossRefGoogle Scholar
  7. 7.
    Gao WD, Liu Y, Marban E. Selective effects of oxygen free radicals on excitation-contraction coupling in ventricular muscle. Implications for the mechanism of stunned myocardium. Circulation. 1996; 94: 2597–2604.PubMedCrossRefGoogle Scholar
  8. 8.
    Holdefer M, Wicomb WN, Levy JV, Collins GM. Cardiotonic effects of reduced sulfhydryl amines after preservation of rabbit hearts. J. Heart Lung Transplant. 1994; 13: 157–159.PubMedGoogle Scholar
  9. 9.
    Kevelaitis E, Mouas C, Menasché Ph. Poststorage diastolic abnormalities of heart transplants: Is vascular dysfunction or myocardial contracture the culprit? J. Heart Lung Transplant. 1996; 15: 461–469.PubMedGoogle Scholar
  10. 10.
    Menasché Ph, Termignon JL, Pradier F et al. Experimental evaluation of Celsior®, a new heart preservation solution. Eur. J Cardio-thorac. Surg. 1994; 8: 207–213.CrossRefGoogle Scholar
  11. 11.
    Evans PJ, Tredger M, Dunne JB, Halliwell B. Catalytic metal ions and the loss of reduced glutathione from University of Wisconsin preservation solution. Transplantation. 1996; 62: 1046–1049.PubMedCrossRefGoogle Scholar
  12. 12.
    Sumimoto R, Dohi K, Fukuda Y, Urushihara T, Sumimoto K, Kamada N. A comparison of histidine lactobionate solution with University of Wisconsin solution for rat liver and heart preservation. Transplant. Int. 1992; 5(Suppl 1): S408–410.Google Scholar
  13. 13.
    Lopez JR, Jahangir R, Jahangir A, Shen WK, Terzic A. Potassium channel openers prevent potassium-induced calcium loading of cardiac cells: possible implications in cardioplegia. J. Thorac. Cardiovasc. Surg. 1996; 112: 820–831.PubMedCrossRefGoogle Scholar
  14. 14.
    Gu K, Kin S, Saitoh Y et al. Cardioprotective effect of nicorandil in histidine-tryptophanketoglutarate solution during the cold storage of isolated hearts. Transplantation. 1996; 61: 1572–1575.PubMedCrossRefGoogle Scholar
  15. 15.
    Myers ML, Karmazyn M. Improved cardiac function after prolonged hypothermic ischemia with the Na + /H + exchange inhibitor HOE 694. Ann. Thorac. Surg. 1996; 61: 1400–1406.PubMedCrossRefGoogle Scholar
  16. 16.
    Chan BBK, Kron IL, Flanagan TL, Kern JA, Hobson, Tribble CG. Impairment of vascular endothelial function by high-potassium storage solutions. Ann. Thorac. Surg. 1993; 55: 940–945.PubMedCrossRefGoogle Scholar
  17. 17.
    Cartier R, Hollmann C, Dagenais F, Buluran J, Pellerin M, Leclerc Y. Effects of University of Wisconsin solution on endothelium-dependent coronary artery relaxation in the rat. Ann. Thorac. Surg. 1993; 55: 50–56.PubMedCrossRefGoogle Scholar
  18. 18.
    Lee J, Drinkwater DC, Laks H et al. Preservation of endothelium-dependent vasodilation with low-potassium University of Wisconsin solution. J. Thorac. Cardiovasc. Surg. 1996; 112: 103–110.PubMedCrossRefGoogle Scholar
  19. 19.
    He GW, Yang CQ, Yang JA. Depolarizing cardiac arrest and endothelium-derived hyperpolarizating factor-mediated hyperpolarization and relaxation in coronary arteries: The effect and mechanism. J. Thorac. Cardiovasc. Surg. 1997; 113: 932–941.PubMedCrossRefGoogle Scholar
  20. 20.
    Drinkwater DC, Rudis E, Laks H et al. University of Wisconsin solution versus Stanford cardioplegic solution and the develoment of cardiac allograft vasculopathy. J. Heart Lung Transplant. 1995; 14: 891–896.PubMedGoogle Scholar
  21. 21.
    Jovanovic A, Alekseev AE, Lopez JR, Shen WK, Terzic A. Adenosine prevents hyperkalemiainduced calcium loading in cardiac cells: relevance for cardioplegia. Ann. Thorac. Surg. 1997; 63: 153–161.PubMedCrossRefGoogle Scholar
  22. 22.
    Katayama O, Ledingham S, Amrani M et al. Functional and metabolic effects of adenosine in cardioplegia: role of temperature and concentration. Ann. Thorac. Surg. 1997; 63: 449–455.PubMedCrossRefGoogle Scholar
  23. 23.
    Mizuno A, Baretti R, Buckberg GD et al. Endothelial stunning and myocyte recovery after reperfusion of jeopardized muscle: a role of L-arginine blood cardioplegia. J. Thorac. Cardiovasc. Surg. 1997; 113: 379–389.PubMedCrossRefGoogle Scholar
  24. 24.
    Demmy TL, Biddle JS, Bennett LE, Walls JT, Schmaltz MA, Curtis JJ. Organ preservation solutions in heart transplantation - patterns of usage and related survival. Transplantation. 1997; 63: 262–269.PubMedCrossRefGoogle Scholar
  25. 25.
    Wheeldon D, Sharpies L, Wallwork J, English T. Donor heart preservation survey. J. Heart Lung Transplant. 1992; 11: 986–993.PubMedGoogle Scholar
  26. 26.
    Piétri S, Culcasi M, Albat B, Albérici G, Menasché Ph. Direct assessment of the antioxidant effects of a new heart preservation solution, Celsior. A hemodynamic and electron spin resonance study. Transplantation. 1994; 58: 739–742.PubMedGoogle Scholar
  27. 27.
    Rodeheffer RJ, Naftel DC, Warner-Stevenson L et al. Secular trends in cardiac transplant recipient and donor management in the United States, 1990 to 1994. A multi-institutional study. Circulation. 1996; 94: 2883–2889.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • P. Menasché

There are no affiliations available

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