101
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Remadi JP, Baron O, Roussel JC, Al Habash O, Treilhaud M, Despins P, Duveau D, Michaud JL. Myocardial preservation using Celsior solution in cardiac transplantation: early results and 5-year follow-up of a multicenter prospective study of 70 cardiac transplantations. Ann Thorac Surg 2002; 73:1495-9. [PMID: 12022539 DOI: 10.1016/s0003-4975(02)03424-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Several storage methods using a wide variety of extracellular or intracellular solutions applied either as continuous perfusion, intermittent perfusion, or simple immersion of the heart have been commonly used. We have performed a prospective randomized multicenter study of 70 cardiac transplantation recipients to evaluate the Celsior solution for cardiac preservation. METHODS Seventy consecutive patients were included in this trial and received a cardiac graft arrested and preserved with Celsior. The first follow-up period was 1 month. The mean age of the recipients was 49 years (range, 28 to 66 years), and 81.7% were male. The main disease was nonobstructive cardiomyopathy (64.3%). The age range of donors was between 14 and 56 years with a mean of 33 years. The majority of grafts (73%) were stored in 1 L of Celsior. A midterm follow-up at 5 years was performed and was 100% complete. RESULTS The operative mortality (<30-day) rate was 6 of 70 (8.6%). Sixty-three patients (90%) had at least satisfactory hemodynamic measurements on day 2. The first postoperative echocardiograms showed good myocardial performance for 90% of the grafts. Actuarial survival rate at 5 years was 75% +/- 5.1%. CONCLUSIONS The use of Celsior in cardiac transplantation was safe and very effective. This solution proved very valuable in at-risk patients.
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Affiliation(s)
- Jean-Paul Remadi
- Department of Anesthesiology, The G and R Laënnec University Hospital, Nantes, France.
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102
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Meneu Diaz JC, Vicente E, Nuño J, Quijano Y, Lopez-Hervás P, Bárcena R, Honrubia A, Sanchez S, Rodriguez G. Prospective comparative study of the efficacy of Celsior solution for preservation in clinical liver transplant. Transplant Proc 2002; 34:49. [PMID: 11959180 DOI: 10.1016/s0041-1345(01)02661-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J C Meneu Diaz
- Unidad de Trasplante Hepatointestinal, Hospital Universitario Ramon y Cajal, Madrid, Spain
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103
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Ohwada S, Sunose Y, Aiba M, Tsutsumi H, Iwazaki S, Totsuka O, Matsumoto K, Takeyoshi I, Morishita Y. Advantages of Celsior solution in graft preservation from non-heart-beating donors in a canine liver transplantation model. J Surg Res 2002; 102:71-6. [PMID: 11796001 DOI: 10.1006/jsre.2001.6296] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The optimal method for preserving livers from non-heart-beating donors (NHBD) is still unknown. We compared the Celsior solution, a new extracellular-type, low-potassium, low-viscosity preservation solution, with the University of Wisconsin (UW) solution in a canine orthotopic liver transplantation from NHBD. MATERIALS AND METHODS Fourteen adult mongrel dogs, weighing 9 to 17 kg, were divided into two groups: the Celsior or the UW group (n = 7 each). The thoracic descending aorta and supradiaphragmatic inferior vena cava were cross-clamped for 20 min to induce warm ischemia as a NHBD model. The liver was flushed with the respective cold preservation solution and then stored at 4 degrees C for 4 h. The grafts were transplanted using the piggy-back technique under portal decompression by leaving the native right lobe as a temporary shunt. RESULTS The duration of liver flushing out (min) was shorter (P < 0.05), and the serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, lactate dehydrogenase, lactate, and alpha-glutathione S-transferase concentrations 2 and 6 h after reperfusion of the graft (RPF) were lower (P < 0.05) in the Celsior group than in the UW group. Hepatic tissue blood flow (HTBF) did not deteriorate as much (P < 0.05) in the Celsior group. The serum endothelin-1 level was lower (P < 0.05) in the Celsior group 2 h after RPF. Histopathology of liver specimens revealed portal congestion and hepatocyte necrosis with neutrophil infiltration in the UW group, while these findings were mild in the Celsior group. CONCLUSIONS The Celsior solution improves vascular endothelial injury in livers from NHBDs and may have advantages in graft flush and preservation of grafts from NHBDs.
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Affiliation(s)
- Susumu Ohwada
- Second Department of Surgery, Gunma University Faculty of Medicine, 3-39-15 Showa-Machi, Maebashi, 371-8511, Japan.
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104
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Lama C, Rafecas A, Figueras J, Torras J, Ramos E, Fabregat J, Busquets J, Garcia-Barrasa A, Jaurrieta E. Comparative study of Celsior and Belzer solutions for hepatic graft preservation: preliminary results. Transplant Proc 2002; 34:54-5. [PMID: 11959183 DOI: 10.1016/s0041-1345(01)02664-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- C Lama
- Liver Transplant Unit, C.S.U. Bellvitge, Barcelona, Spain
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105
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Ngimbous BB, Bourgeois F, Mas C, Simonneau M, Moalic JM. Heart transplantation changes the expression of distinct gene families. Physiol Genomics 2001; 7:115-26. [PMID: 11773598 DOI: 10.1152/physiolgenomics.00013.2001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We took advantage of the combination of a rat heart transplantation model with a modified differential display RT-PCR method to identify transcriptome changes in the right atria from transplanted compared with native hearts. Based on sequence homology search, the 37 cDNAs differentially displayed both 2 and 7 days posttransplantation were categorized into 7 unknown transcripts, 16 expressed sequence tags (ESTs), and 14 partially or completely characterized genes. The last group cDNAs, validated by relative RT-PCR, belonged to diverse gene families involved in specific metabolisms, protein synthesis, cell signaling, and transcription. Furthermore, we identified differential transcripts corresponding to denervation and fetal gene reexpression. We found coordinate downregulation of genes involved in energy metabolism and protein synthesis regulation, similar to that reported for senescent skeletal muscle. From these transcriptome changes, we propose that heart transplants and senescent muscles share common molecular mechanisms.
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Affiliation(s)
- B B Ngimbous
- Unité 127, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Lariboisière, 75475 Paris Cedex, France
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106
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Bergamaschini L, Gobbo G, Gatti S, Caccamo L, Prato P, Maggioni M, Braidotti P, Di Stefano R, Fassati LR. Endothelial targeting with C1-inhibitor reduces complement activation in vitro and during ex vivo reperfusion of pig liver. Clin Exp Immunol 2001; 126:412-20. [PMID: 11737055 PMCID: PMC1906211 DOI: 10.1046/j.1365-2249.2001.01695.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Tissue damage during cold storage and reperfusion remains a major obstacle to wider use of transplantation. Vascular endothelial cells and complement activation are thought to be involved in the inflammatory reactions following reperfusion, so endothelial targeting of complement inhibitors is of great interest. Using an in vitro model of human umbilical vein endothelial cells (HUVEC) cold storage and an animal model of ex vivo liver reperfusion after cold ischaemia, we assessed the effect of C1-INH on cell functions and liver damage. We found that in vitro C1-INH bound to HUVEC in a manner depending on the duration of cold storage. Cell-bound C1-INH was functionally active since retained the ability to inhibit exogenous C1s. To assess the ability of cell-bound C1-INH to prevent complement activation during organ reperfusion, we added C1-INH to the preservation solution in an animal model of extracorporeal liver reperfusion. Ex vivo liver reperfusion after 8 h of cold ischaemia resulted in plasma C3 activation and reduction of total serum haemolytic activity, and at tissue level deposition of C3 associated with variable level of inflammatory cell infiltration and tissue damage. These findings were reduced when livers were stored in preservation solution containing C1-INH. Immunohistochemical analysis of C1-INH-treated livers showed immunoreactivity localized on the sinusoidal pole of the liver trabeculae, linked to sinusoidal endothelium, so it is likely that the protective effect was due to C1-INH retained by the livers. These results suggest that adding C1-INH to the preservation solution may be useful to reduce complement activation and tissue injury during the reperfusion of an ischaemic liver.
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Affiliation(s)
- L Bergamaschini
- Department of Internal Medicine, Ospedale Maggiore IRCCS, Milan, Italy.
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107
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Faenza A, Catena F, Nardo B, Montalti R, Capocasale E, Busi N, Boggi U, Vistoli F, Di Naro A, Albertazzi A, Mosca F, Cavallari A. Kidney preservation with university of Wisconsin and Celsior solution: a prospective multicenter randomized study. Transplantation 2001; 72:1274-7. [PMID: 11602855 DOI: 10.1097/00007890-200110150-00016] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although the University of Wisconsin (U.W.) solution continues to be the most commonly used for intra-abdominal organs, a new solution, Celsior, already used for heart and lungs, has been proposed for kidney and liver preservation. The aim of this research was to assess the effect of Celsior as compared with U.W. on immediate graft function and a 2-year follow-up of kidney transplants. METHODS A prospective multicenter randomized study was designed to evaluate the efficacy of the Celsior solution in the clinical preservation of the kidney. In this report, we present the data collected as of September 2000. One hundred donors were included in the trial resulting in 187 renal transplants. Ninety-nine kidneys were stored in Celsior solution and 88 in U.W. solution. The groups were comparable with regard to donor and recipient characteristics. RESULTS Delayed graft function occurred in 31.3% of the Celsior group and in 33.9% of the U.W. group (P=n.s.). Mean serum creatinine levels and mean daily urinary output were also comparable. Two year graft survival in kidneys preserved with Celsior was 84% as compared with 75% for U.W.-preserved kidneys without any significant statistical difference. CONCLUSIONS Our data show that the preservation of kidneys in Celsior solution in a clinical setting is equivalent to that of U.W. solution. When using Celsior during multiple-organ donor harvesting it would be possible to perform an in situ flush of all intra-abdominal and intrathoracic organs with a single cold storage solution.
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Affiliation(s)
- A Faenza
- Department of Surgery and Transplantation, University of Bologna, Bologna, Italy
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108
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Compagnon P, Clément B, Campion JP, Boudjema K. Effects of hypothermic machine perfusion on rat liver function depending on the route of perfusion. Transplantation 2001; 72:606-14. [PMID: 11544418 DOI: 10.1097/00007890-200108270-00008] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND METHODS The aim of this study was to evaluate the efficacy of hypothermic machine perfusion (HMP) to preserve rat livers according to the route of perfusion, i.e., via portal vein, hepatic veins (retrograde), or hepatic artery. Livers were preserved for 24 or 48 hr by simple cold storage (SCS) or by HMP. Preservation solution was supplemented with (HMP) or without (SCS) hydroxyethyl starch. After preservation, grafts were reperfused for 2 hr with an oxygenated Krebs-Henseleit bicarbonate buffer. RESULTS After 24 hr of preservation, total glutathione concentrations in HMP livers were similar (1287+/-37, 1418+/-118, and 1471+/-62 nmol/g in hepatic artery, portal vein, and hepatic vein HMP livers, respectively) and higher than in the SCS (833+/-118 nmol/g, P<0.05) group. These higher total glutathione values were due to higher reduced glutathione concentrations. ATP concentrations in the liver tissue were similar in HMP groups (0.75+/-0.4, 0.64+/-0.1, and 0.77+/-0.1 micromol/g in hepatic artery, portal vein, and hepatic vein HMP livers, respectively) and higher than in SCS (0.32+/-0.06 micromol/g, P<0.05). After 2 hr of normothermic reperfusion, bile production in the HMP portal and HMP retrograde groups were similar (391+/-29 ml and 372+/-25 ml) and higher than in the HMP artery or SCS groups (275+/-25 ml and 277+/-32 ml, respectively; P<0.05). Aspartate transaminase, alanine transaminase, lactate dehydrogenase, and purine nucleoside phosphorylase release into the perfusate of HMP portal and HMP retrograde perfused livers was similar and significantly lower compared to the HMP artery and SCS groups. At the end of reperfusion, no statistical differences were found for glutathione concentration and energetic reserves in the livers of each group. After 48 hr of preservation, livers from the HMP portal and HMP retrograde groups did significantly better than livers from the HMP artery or SCS groups. CONCLUSIONS This study confirms the superiority of HMP over SCS to preserve the liver graft. It shows that retrograde perfusion is similar to PV perfusion and that perfusion by HA is less beneficial.
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Affiliation(s)
- P Compagnon
- INSERM U-456, Detoxification and Tissue Repair Unit, University of Rennes I, France
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109
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Audet M, Alexandre E, Mustun A, David P, Chenard-Neu MP, Tiollier J, Jaeck D, Cinqualbre J, Wolf P, Boudjema K. Comparative evaluation of Celsior solution versus Viaspan in a pig liver transplantation model. Transplantation 2001; 71:1731-5. [PMID: 11455250 DOI: 10.1097/00007890-200106270-00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In a pig liver transplantation model, we compared the effects of Celsior solution (CS), an extracellular preservation solution, with Viaspan (University of Wisconsin solution, UW) on graft function and animal survival. METHODS Pig livers were flushed with either CS or UW solution and cold-stored for 12 hr (group 1) or for 8 to 10 hr (group 2). Grafts were transplanted orthotopically. Intrahepatic reduced and oxidized glutathione and adenine nucleotides were evaluated 1 hr after reperfusion. Liver function of transplanted animals was monitored for up to 6 days by serum transaminases, total bilirubin, purine nucleoside phosphorylase, and prothrombin levels. RESULTS In group 1, all animals died within 24 hr after reperfusion regardless of the preservation solution used. In group 2, no significant difference was seen in survival between the CS (72%) and the UW (67%) groups 6 days after transplantation, and there were no statistically significant differences in the biochemical data. There were no differences in histological evaluation of the livers at the time of death or killing of the animals between the CS and UW groups. CONCLUSION Within the limits of this pilot study, CS is equivalent to UW in terms of graft function and animal survival.
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Affiliation(s)
- M Audet
- Service de Chirurgie Générale et de Transplantation, Hôpital de Hautepierre, 67098 Strasbourg, France.
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110
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Baxter K, Howden BO, Jablonski P. Heart preservation with celsior solution improved by the addition of nitroglycerine. Transplantation 2001; 71:1380-4. [PMID: 11391222 DOI: 10.1097/00007890-200105270-00004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preservation of rat hearts was extended to 16 hr when nitroglycerine (NTG) was added to colloid-free University of Wisconsin solution (MUW). This study examined the effectiveness of Celsior solution (CEL) and whether adding NTG to CEL would improve and extend cardiac preservation. METHODS Two studies were conducted: (a) 9-hr preservation with either CEL or MUW, (b) 16-hr preservation with CEL, CEL+NTG, or MUW+NTG. Rat heart isografts were flushed and stored at 0 degrees C before heterotopic transplantation with an indwelling externalized intraventricular balloon-tipped catheter. One and 7 days after transplantation, quantitative functional studies were performed. RESULTS After 9-hr preservation, all (6/6) grafts preserved with MUW beat for 7 days, whereas only 1/6 hearts preserved with CEL continued to beat. After 16-hr preservation, 6/10 CEL+NTG hearts beat for 7 days compared with 7/8 MUW+NTG hearts; none of the hearts preserved with CEL survived. Function was similar in CEL+NTG and MUW+NTG groups on day 1 (left ventricular developed pressure (LVDP): CEL+NTG=64+/-16, MUW+NTG=104+/-16 mmHg; maximum dP/dt: CEL+ NTG=2024+/-551, MUW+NTG=3582+/-513 mmHg/sec) and day 7: (LVDP: CEL+NTG=126+/-25, MUW+NTG=177+/-24 mmHg; maximum dP/dt: CEL+NTG=3835+/-848, MUW+ NTG=5639+/-670 mmHg/sec). Function in both groups improved significantly (P<0.05) on day 7 compared with day 1. CONCLUSIONS Celsior was not as effective as MUW for rat heart preservation. The addition of NTG to both CEL and MUW provided similar effective preservation for 16 hr. NTG should be added routinely to both solutions.
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Affiliation(s)
- K Baxter
- Monash University, Department of Surgery, Monash Medical Centre, Level 5, Block E, 246 Clayton Road, Clayton, Vic 3168, Australia
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111
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Perrault LP, Nickner C, Desjardins N, Dumont E, Thai P, Carrier M. Improved preservation of coronary endothelial function with Celsior compared with blood and crystalloid solutions in heart transplantation. J Heart Lung Transplant 2001; 20:549-58. [PMID: 11343982 DOI: 10.1016/s1053-2498(01)00242-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Endothelial injury from preservation solutions has been implicated in acute coronary vasospasm and pathologic activation of the endothelium, which can contribute to the development of graft coronary vasculopathy after heart transplantation. Preservation solutions with a powerful antioxidant capacity may decrease the occurrence of these complications. MATERIALS AND METHODS This study was designed to evaluate the effect of Celsior (an anti-oxidant solution specifically designed for cardiac preservation) in a model of heart preservation (4 hours at 4 degrees C to reproduce the situation encountered in clinical heart transplantation) compared two commonly used cardioplegic and preservation strategies on coronary endothelial function. Endothelium-dependent relaxation of normal porcine epicardial coronary arteries to serotonin (5-HT, an agonist that activates 5-HT(1d) receptors coupled to Gi proteins) and bradykinin (BK, which activates B2 receptors coupled to Gq proteins) was studied in standard organ chamber experiments in the following groups: a control group was submitted to immediate excision without cardioplegia and preserved in saline solution (0.9% NaCl) for 4 hours (Group 1); two groups had cardioplegia induced with a crystalloid solution and were stored for 4 hours in saline (Group 2) or 4 hours in Celsior solution (Group 3); and two groups had cardioplegia induced with normothermic blood cardioplegia and were stored for 4 hours in the saline (Group 4), or 4 hours in Celsior solution (Group 5). Finally, two groups underwent cardioplegia with Celsior and were stored for 4 hours in saline (Group 6), or 4 hours in the Celsior solution (Group 7). All cardioplegia solutions were at 4 degrees C (except blood cardioplegia at 37 degrees C) and all preservations solutions were at 4 degrees C. RESULTS Endothelium-dependent relaxations to serotonin were significantly decreased in all groups except the Celsior + Celsior group compared with the control group. There were no significant differences in relaxation to bradykinin except in one group. Use of the Celsior solution for induction of cardioplegia and storage better preserved endothelium-dependent G-protein-mediated relaxation compared with the other arrest and preservation strategies. CONCLUSIONS The observed effect may be associated with an improvement in both short- and long-term outcome in heart transplantation, especially because these alterations may be further compounded by reperfusion.
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Affiliation(s)
- L P Perrault
- Research Center, Department of Surgery, Montreal Heart Institute, Quebec, Canada.
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112
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Vega JD, Ochsner JL, Jeevanandam V, McGiffin DC, McCurry KR, Mentzer RM, Stringham JC, Pierson RN, Frazier OH, Menkis AH, Staples ED, Modry DL, Emery RW, Piccione W, Carrier M, Hendry PJ, Aziz S, Furukawa S, Pham SM. A multicenter, randomized, controlled trial of Celsior for flush and hypothermic storage of cardiac allografts. Ann Thorac Surg 2001; 71:1442-7. [PMID: 11383780 DOI: 10.1016/s0003-4975(01)02458-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A multicenter, randomized, controlled, open-label trial was conducted to evaluate the safety and efficacy of Celsior when used for flush and hypothermic storage of donor hearts before transplantation. METHODS Heart transplant recipients were randomized to one of two treatment groups in which donor hearts were flushed and stored in either Celsior or conventional preservation solution(s) (control). Study subjects were followed for 30 days after transplantation. RESULTS A total of 131 heart transplant recipients were enrolled (Celsior, n = 64; control, n = 67). The treatment groups were evenly distributed in donor and recipient base line characteristics. Graft loss rate was lower in the Celsior group on day 7 (3% versus 9%) and on day 30 (6% versus 13%), but the difference was not statistically significant based on 95% confidence interval analysis. No significant difference was measured between the Celsior and control groups in 7-day patient survival (97% versus 94%) and the proportion of patients with one or more adverse events (Celsior, 88%; control 87%) or serious adverse events (Celsior, 38%; control, 46%). Significantly fewer patients in the Celsior group developed at least one cardiac-related serious adverse event (13% versus 25%). CONCLUSIONS Celsior was demonstrated to be as safe and effective as conventional solutions for flush and cold storage of cardiac allografts before transplantation.
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Affiliation(s)
- J D Vega
- Emory University Hospital, Atlanta, Georgia, USA.
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113
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Tsutsumi H, Oshima K, Mohara J, Takeyoshi I, Aizaki M, Tokumine M, Matsumoto K, Morishita Y. Cardiac transplantation following a 24-h preservation using a perfusion apparatus. J Surg Res 2001; 96:260-7. [PMID: 11266282 DOI: 10.1006/jsre.2001.6077] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND We developed a new apparatus for heart preservation and have already reported successful transplantation following 12 h of preservation using this apparatus. The efficacy of coronary perfusion with an oxygenated Celsior solution was investigated through transplantation following 24 h of preservation using the apparatus. MATERIALS AND METHODS After being harvested, grafts were preserved with a combination of immersion in a 4 degrees C Celsior solution and perfusion with an oxygenated Celsior solution using the apparatus in the coronary perfusion (CP) group and simply immersed in a 4 degrees C Celsior solution in the simple immersion(SI) group. beta-Adenosine triphosphate (beta-ATP), phosphocreatine (Pcr), and inorganic phosphate (P(i)) levels and myocardial pH (pH(i)) were measured immediately after the heart was excised and at 12 and 24 h after preservation. Following preservation, orthotopic transplantation was performed. Cardiac function was measured 2 h after weaning from cardiopulmonary bypass (CPB). RESULTS beta-ATP/P(i), Pcr/P(i), and pH(i) levels were significantly higher in the CP group than in the SI group at 12 and 24 h after preservation. Four of six animals in the CP group and two of six in the SI group were successfully weaned from CPB. The recovery rates of cardiac function were better in the CP group than in the SI group. CONCLUSION Twenty-four hours of heart preservation may be possible with a combination of immersion in a 4 degrees C Celsior solution and perfusion with an oxygenated Celsior solution using the perfusion apparatus.
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Affiliation(s)
- H Tsutsumi
- Second Department of Surgery, Gunma University School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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114
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Nardo B, Catena F, Cavallari G, Montalti R, Di Naro A, Faenza A, Cavallari A. Randomized clinical study comparing UW and Celsior solution in liver preservation for transplantation: preliminary results. Transplant Proc 2001; 33:870-2. [PMID: 11267110 DOI: 10.1016/s0041-1345(00)02357-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- B Nardo
- Department of Surgery and Transplantations, University of Bologna, Bologna, Italy
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115
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Baldan N, Rigotti P, Furian L, Valente ML, Calabrese F, Di Filippo L, Parise P, Sarzo G, Frison L, Ancona E. Pancreas preservation with Celsior solution in a pig autotransplantation model: comparative study with University of Wisconsin solution. Transplant Proc 2001; 33:873-5. [PMID: 11267111 DOI: 10.1016/s0041-1345(00)02358-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- N Baldan
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Padova, Padova, Italy
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116
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Ohwada S, Sunose Y, Tsutsumi H, Iwazaki S, Aiba M, Kasahara M, Kawashima Y, Takeyoshi I, Matsumoto K, Morishita Y. Celsior is superior to UW for graft preservation from non-heart-beating donors in a canine liver transplantation model. Transplant Proc 2001; 33:922-3. [PMID: 11267130 DOI: 10.1016/s0041-1345(00)02270-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- S Ohwada
- Second Department of Surgery, Gunma University Faculty of Medicine, Maebashi, Japan
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117
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Tsutsumi H, Takeyoshi I, Oshima K, Mohara J, Aizaki M, Morishita Y. The Effect of Coronary Perfusion with an Oxygenated Celsior Solution on 12-hour Cardiac Preservation. Int J Angiol 2001; 10:15-19. [PMID: 11178780 DOI: 10.1007/bf01616337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Celsior is a new extracellular-type cardiac preservation solution. We recently developed an apparatus for preservation using low-pressure continuous coronary perfusion. The purpose of this study was to investigate the efficacy of coronary perfusion with an oxygenated Celsior solution using the new apparatus for prolonged cardiac preservation. Adult mongrel dogs weighing 9-13 kg were divided into two groups: the coronary perfusion group (CP; n = 5) and the simple immersion group (SI; n = 7). The coronary vascular beds were washed out with a 4 degrees C Celsior solution following cardiac arrest using the same solution, and their hearts were excised. In the CP group, the graft was immersed in a 4 degrees C Celsior solution and perfused with the same oxygenated solution. In the SI group, the graft was simply immersed in a 4 degrees C Celsior solution. beta-adenosine triphosphate (beta-ATP), phosphocreatine (Pcr), inorganic phosphate (Pi) levels and myocardial pH (pHi) were measured immediately after excising the heart, and at 3, 6, and 12 hours after preservation. beta-ATP, Pcr, and Pi values were expressed as a percentage of control values, which were measured immediately after excising the heart. beta-ATP/Pi and Pcr/Pi levels were significantly higher in the CP group than in the SI group at 6 and at 12 hours after preservation. The pHi levels during preservation were significantly higher in the CP group than in the SI group. Low-pressure hypothermic coronary perfusion with an oxygenated Celsior solution is effective for long-term heart preservation. </hea
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Affiliation(s)
- Hirofumi Tsutsumi
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Gunma, Japan
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118
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Tolba RH, Akbar S, Puetz U, Minor T. Current organ preservation solutions for liver preservation: experimental comparison. Transplant Proc 2000; 32:1673-4. [PMID: 11119886 DOI: 10.1016/s0041-1345(00)01421-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R H Tolba
- Division of Surgical Research, Surgical Clinic, University of Bonn, Bonn, Germany
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119
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Tsutsumi H, Takeyoshi I, Ohshima K, Mohara J, Aizaki M, Morishita Y. Effect of coronary perfusion with an oxygenated Celsior solution on 24-hour preservation in canine hearts. Transplant Proc 2000; 32:2415-6. [PMID: 11120223 DOI: 10.1016/s0041-1345(00)01722-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- H Tsutsumi
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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120
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Aizaki M, Takeyoshi I, Oshima K, Mohara J, Tsutsumi H, Koyano T, Tokumine M, Ishikawa S, Morishita Y. Effects of Celsior solution on long-term preservation of canine hearts with a new portable hypothermic perfusion apparatus: a preliminary study. Transplant Proc 2000; 32:2409-10. [PMID: 11120220 DOI: 10.1016/s0041-1345(00)01719-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- M Aizaki
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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121
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Kevelaitis E, Oubenaissa A, Mouas C, Peynet J, Menasché P. Opening of mitochondrial potassium channels: a new target for graft preservation strategies? Transplantation 2000; 70:576-8. [PMID: 10972212 DOI: 10.1097/00007890-200008270-00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study was designed to assess the protective effects of the mitochondrial adenosine triphosphate-sensitive potassium channel (KATP) opener diazoxide as an additive to heart preservation solution. METHODS Forty isolated isovolumic buffer-perfused rat hearts were divided into four groups. Groups I and III hearts were arrested with and cold-stored in Celsior solution for 4 hr and 10 hr, respectively. In Groups II and IV, hearts underwent a protocol similar to that used in Group I and III, respectively, except that Celsior was supplemented with 100 micromol/L of diazoxide. RESULTS The protective effects of diazoxide were primarily manifest as a better preservation of diastolic function and a reduction of myocardial edema. The improvement of postischemic systolic function was observed only after prolonged exposure to diazoxide in Group IV, compared with Group III. The endothelium-dependent and endothelium-independent coronary flow postischemic responses were not affected by the supplementation of Celsior with diazoxide. CONCLUSIONS Pharmacologic activation of mitochondrial KATP channels seems to be an effective means of improving preservation of cold-stored hearts, which is consistent with the presumed role of these channels as end effectors of the cardioprotective preconditioning pathway.
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Affiliation(s)
- E Kevelaitis
- Department of Physiology, Kaunas Medical University, Lithuania
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122
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Ferrera R, Michel P, Hadour G, Chiari P, Chambers D, Rodriguez C. Microperfusion techniques for long-term hypothermic preservation. J Heart Lung Transplant 2000; 19:792-800. [PMID: 10967274 DOI: 10.1016/s1053-2498(00)00146-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The aim of this study was to compare several methods of hypothermic heart preservation. METHODS We preserved isolated pig hearts for 24 hours in cold cardioplegia (4 degrees C), using either continuous microperfusion (Group I) or simple storage (Group II), and with a new preservative solution (NPS, groups IA and IIA) vs St. Thomas' solution (groups IB and IIB). The main characteristics of the NPS include (1) prevention of cell swelling with polyethelene glycol (PEG), (2) low calcium and magnesium, and (3) presence of metabolic substrates, such as glucose, insulin, pyruvate, aspartate, alanyl-glutamine, and membrane stabilization compounds such as ethanol and chlorpromazine. RESULTS The 4 above groups were compared with hearts harvested and immediately reperfused (control group). During preservation, only Group IB showed significant edema (40% +/- 8.4% water gain). Adenylate charge was 25% to 50% higher in microperfused Groups IA and IB (0.678 +/- 0.049 and 0.795 +/- 0.071, respectively) as compared with simple-storage groups IIA and IIB (0.605 +/- 0.048 and 0.524 +/- 0.160, respectively). Ultrastructural analysis showed that tissue injury occurred mainly in Group IIB (altered mitochondria, chromatin clumping). Functional data showed better recovery of NPS groups as compared with St. Thomas groups: coronary flow was identical in Group IB and control (57.8 +/- 22 and 56.6 +/- 14 ml/min/100 g, respectively), and in IA > IB (p < 0.001) and IIA > IIB (p < 0.01); the rate pressure products were higher in NPS groups compared with St. Thomas groups (IA > IB, p < 0.01); IIA > IIB, p < 0.05). CONCLUSIONS The microperfusion method associated with the NPS provides excellent protection in long-term hypothermic heart preservation.
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Baldan N, Parise P, Furian L, Savio ML, Valente ML, Calabrese F, Venturini R, Girotto A, Rigotti P. Swine pancreas preservation with Celsior solution. Transplant Proc 2000; 32:29-31. [PMID: 10700955 DOI: 10.1016/s0041-1345(99)00863-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- N Baldan
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Padova, Italy
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125
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Maggi U, Caccamo L, Gatti S, Paone G, Reggiani P, Rossi G, Latham L, Vannelli A, Melada E, Brambilla R, Damilano I, Trezza P, Fassati LR. Celsior solution and clinical liver transplantation. Transplant Proc 2000; 32:36-7. [PMID: 10700958 DOI: 10.1016/s0041-1345(99)00866-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- U Maggi
- Centro Trapianti Fegato, Ospedale Maggiore Policlinico IRCCS Milano, Italy
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126
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Nicholson ML. Renal transplantation from non—heart-beating donors: opportunities and challenges. Transplant Rev (Orlando) 2000. [DOI: 10.1016/s0955-470x(00)80007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mohara J, Morishita Y, Takahashi T, Oshima K, Yamagishi T, Takeyoshi I, Matsumoto K. A comparative study of Celsior and University of Wisconsin solutions based on 12-hr preservation followed by transplantation in canine models. J Heart Lung Transplant 1999; 18:1202-10. [PMID: 10612379 DOI: 10.1016/s1053-2498(99)00092-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Celsior is a recently developed extracellular-type preservation solution that is effective in organ preservation. This experimental study was designed to compare the effects of Celsior and University of Wisconsin (UW) solutions in myocardial protection, using 12-hour preservation followed by orthotopic transplantation. METHODS Fourteen pairs of adult mongrel dogs were divided into 2 groups. In the UW group (n = 7), UW solution at 4 degrees C was used for coronary vascular washout and storage following cardiac arrest with glucose-insulin-potassium (GIK) solution. In the Celsior group (n = 7), Celsior solution was used to produce cardiac arrest, for coronary vascular washout, and for storage. After 12-hour cold preservation, orthotopic transplantation was performed under cardiopulmonary bypass (CPB). The rate of recovery (%) of cardiac function of donor hearts was compared 1 and 2 hours after weaning from CPB, and then the transplanted hearts were harvested for histological study. RESULTS Hemodynamic parameters including cardiac output, left ventricular pressure (LVP), and the maximum rates of positive and negative increase of LVP after transplantation were significantly (p < 0.05) higher in the Celsior group than in the UW group 2 hours after weaning from CPB. The transmission electron microscopic study found that degeneration of the mitochondria in the Celsior group was less extensive than in the UW group. CONCLUSION Celsior solution enhanced the cardiac function of hearts preserved for 12 hours prior to transplantation compared to UW solution. Our results indicate that Celsior solution is equivalent or superior to UW solution for cardiac preservation.
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Affiliation(s)
- J Mohara
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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128
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Cascales P, Fernandez-Cornejo V, Sanchez-Del Campo F, de Torre M, Sanchez-Eixeres MR, Soriano N, Gonzalez F. Evaluation of Celsior solution in experimental liver preservation using ex situ isolated rat liver perfusion. Transplant Proc 1999; 31:2437-8. [PMID: 10500660 DOI: 10.1016/s0041-1345(99)00466-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- P Cascales
- Department of Human Anatomy, School of Medicine, Miguel Hernandez University of Elche, Alicante, Spain
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129
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Garlicki M, Kołcz J, Rudziński P, Kapelak B, Sadowski J, Wójcik S, Pietrzyk E, Frasik W, Drukała J, Dziatkowiak A. Myocardial protection for transplantation. Transplant Proc 1999; 31:2079-83. [PMID: 10455976 DOI: 10.1016/s0041-1345(99)00269-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Garlicki
- Department of Cardiac and Vascular Surgery, Jagiellonian University, Kracow, Poland
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130
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Abstract
Eurocollins has almost been abandoned because of the glucose disadvantage. UW is certainly the most used preservation solution for livers, kidneys, and pancreases with excellent clinical and experimental preservation data. UW can certainly be considered the current golden standard solution. However, the disadvantage of high viscosity, high price, uneasy handling of many 1-L bags, and the fact that the radical scavenger glutathion cannot be detected in the bags by chemical analysis (presumably due to diffusion) encourage competitors to produce new compounds with better cost to effect ratios. HTK has a firm place in cardiac preservation; by demonstration of equal safety and efficacy in preserving livers and kidneys, at least in the middle and lower range of cold ischemia time, HTK will be sued more frequently, particularly with the consideration of lower price and more easy handling aspects. The suggested high volume perfusion is not really necessary, calculation based on a total volume of 10 L for a multiorgan donor show significant cost reductions. Celsior is current only used for cardiac preservation. Beyond all aspects of conservation and preservation potencies of all these fluids, it must not be forgotten that cold ischemia itself is a risk factor for organ function. Therefore, cold ischemia time should be kept as short as possible. People are willing to accept 24 hours or more cold ischemia time in kidney transplantation because organ failure can be treated by dialysis. In other organs, where immediate organ function is essential, like in clinical heart transplantation, cold ischemia is hardly ever extended beyond 6 hours. Why are hearts and kidneys so different? Very likely, there is no difference, and the outstanding results in living unrelated kidney transplants is mostly due to short cold ischemia time.
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Affiliation(s)
- F Mühlbacher
- Chirurgische Universitätsklinik Wien, Abteilung für Transplantation, Austria
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131
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Wittwer T, Wahlers T, Fehrenbach A, Cornelius JF, Elki S, Ochs M, Fehrenbach H, Albes J, Haverich A, Richter J. Combined use of prostacyclin and higher perfusate temperatures further enhances the superior lung preservation by Celsior solution in the isolated rat lung. J Heart Lung Transplant 1999; 18:684-92. [PMID: 10452345 DOI: 10.1016/s1053-2498(98)00061-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND The poor tolerance of the lung to ischemia and reperfusion (IR) still represents one of the limitations in clinically successful lung transplantation. Modified Euro-Collins (EC) is routinely used in lung preservation, but alternative solutions have been developed for improvement of pulmonary preservation. Celsior is an extracellular solution that has significantly reduced the IR-induced pulmonary damage in animal studies. So far, no extensive experimental studies exist concerning the influence of Celsior on pulmonary gas exchange following IR. METHODS In an extracorporeal rat lung model 10 lungs, each, were preserved with Celsior (CE) and Celsior/prostacyclin (CEPC, 6 microg/100 ml) at 4 degrees and 15 degrees C, each, and compared to low-potassium Euro-Collins (EC-40, 40 mmol/liter potassium). After 2 hours of ischemia lungs were reventilated and reperfused using a roller pump. Oxygenation in terms of oxygen partial tension in the left atrial effluent, pulmonary vascular resistance (PVR), peak inspiratory pressure, and wet/dry ratio were monitored for 50 minutes. Furthermore, edema formation was evaluated by light microscopy. Statistical analysis was performed using ANOVA models. RESULTS Compared to the EC-40 group, oxygenation was increased and amount of edema was reduced in most Celsior-preserved organs (p<0.032) with exception of the CEPC group at 4 degrees C (p = 0.06). Additional application of prostacyclin did not have any significant effect on oxygenation in the Celsior group. However, after temperature elevation of the CEPC perfusate to 15 degrees C, a superior partial tension of oxygen was observed (p<0.023) in contrast to the 4 degrees C groups CE and CEPC. The lowest PVR was found in the CE 4 degrees C group (p<0.02). CONCLUSIONS Celsior provides better lung preservation than EC-40 solution. Application of prostacyclin at higher perfusate temperatures results in additional functional improvement. In vivo experiments and ultrastructural analysis are warranted for further evaluation of Celsior in lung preservation.
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Affiliation(s)
- T Wittwer
- Division of Cardiothoracic and Vascular Surgery, Medical School Hannover, Germany.
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Kevelaitis E, Peynet J, Mouas C, Launay JM, Menasché P. Opening of potassium channels: the common cardioprotective link between preconditioning and natural hibernation? Circulation 1999; 99:3079-85. [PMID: 10368128 DOI: 10.1161/01.cir.99.23.3079] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The tolerance of hibernating mammals to cold hypoxia is related to a factor similar to agonists of delta-opioid receptors. This study was designed to assess whether activation of these receptors could reproduce the protection conferred by ischemic preconditioning and whether such cardioprotection was similarly mediated by an opening of ATP-sensitive potassium (KATP) channels. METHODS AND RESULTS Thirty-two isolated rat hearts were arrested with and stored in Celsior at 4 degrees C for 5 hours before being reperfused for 2 hours. They were divided into 4 equal groups. Group 1 hearts served as controls. In group 2, ischemic preconditioning was elicited by two 5-minute global ischemia periods interspersed with 5 minutes of reperfusion before arrest. In group 3, hearts were pharmacologically preconditioned with a 15-minute infusion of the delta-opioid receptor agonist D-Ala2-D-Leu5-enkephalin (DADLE; 200 micromol/L). In group 4, the protocol was similar to group 3 except that infusion of DADLE was preceded by infusion of the KATP blocker glibenclamide (50 micromol/L). The salutary effects of both forms of preconditioning were primarily manifest as a better preservation of diastolic function, a reduced myocardial edema, and reduced creatine kinase leakage. This protection was abolished by administration of glibenclamide before DADLE. CONCLUSIONS These data suggest that activation of delta-opioid receptors improves recovery of cold-stored hearts to a similar extent as ischemic preconditioning, most likely through an opening of KATP channels. This provides a rationale for improving the preservation of hearts for transplantation by pharmacologically duplicating the common pathway to natural hibernation and preconditioning.
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Affiliation(s)
- E Kevelaitis
- Department of Physiology, Kaunas Medical University, Lithuania
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133
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Wittwer T, Wahlers T, Cornelius JF, Elki S, Haverich A. Celsior solution for improvement of currently used clinical standards of lung preservation in an ex vivo rat model. Eur J Cardiothorac Surg 1999; 15:667-71. [PMID: 10386415 DOI: 10.1016/s1010-7940(99)00046-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The introduction of Euro-Collins solution with its intracellular electrolyte composition has allowed for clinically accepted pulmonary preservation for up to 7 h of ischemic time. In recent years several alternative solutions have been developed for the improvement of pulmonary preservation. Celsior is an extracellular solution which has significantly reduced the ischemia/reperfusion (IR)-induced pulmonary damage in animal studies. So far, no larger experimental studies exist concerning the influence of Celsior on pulmonary gas exchange following IR. METHODS In an extracorporeal rat lung model ten lungs, were each preserved with Celsior (CE) and Celsior/ prostacycline (CEPC, 6 mg/100 ml) at 4 degrees C and compared with preservation with low-potassium-Euro-Collins solution (LPEC, 40 mmol/l of potassium). After 2 h of ischemia the lungs were re-ventilated and reperfused using a roller-pump. Relative oxygenation capacity (ROC), pulmonary vascular resistance (PVR), peak inspiratory pressure (PIP) and wet/dry ratio were monitored for 50 min. Statistical analysis was performed using ANOVA. RESULTS ROC was increased in all Celsior preserved organs compared with the EC group (P < 0.032). Though the CEPC group was found to have the lowest PIP and the least amount of lung water as assessed by wet/dry ratio, PVR was highest after 30-50 min. The significantly lowest PVR was determined in the CE group (P < 0.02). CONCLUSIONS Celsior provides better lung preservation than LPEC solution, as demonstrated by a significantly increased oxygenation ability, a lower PVR and a decreased wet/ dry ratio. In vivo experiments and additional histological analysis are warranted for further evaluation of Celsior in lung preservation.
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Affiliation(s)
- T Wittwer
- Division of Cardiovascular and Vascular Surgery, Medical School Hannover, Germany.
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134
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Solution development in organ preservation: The University of Wisconsin perspective. Transplant Rev (Orlando) 1999. [DOI: 10.1016/s0955-470x(99)80048-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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135
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Xiong L, Legagneux J, Wassef M, Oubenaïssa A, Détruit H, Mouas C, Menasché P. Protective effects of Celsior in lung transplantation. J Heart Lung Transplant 1999; 18:320-7. [PMID: 10226896 DOI: 10.1016/s1053-2498(98)00032-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Celsior is a new preservation solution for heart transplants that recently has been shown also to improve protection of pulmonary grafts. As these data were obtained in isolated lung preparations, we sought to perform further tests with an in vivo model of allogeneic lung transplantation. METHODS The left lungs of 41 rats were either transplanted immediately after harvest (controls) or flushed with and cold stored in Celsior or the blood-based Wallwork solution for 5 or 12 hours. Lungs were then reperfused for 30 minutes, after which ligation of the contralateral pulmonary artery and bronchus made the recipient rat exclusively dependent on the transplanted lung. Assessment of preservation was made on functional (blood gases, pulmonary hemodynamics) and structural (dry-to-weight ratio, light microscopy, myeloperoxidase [MPO] content) end points. RESULTS The protective effects of Celsior were primarily manifest, once the contralateral lung had been functionally excluded, as a better preservation of oxygen tensions in the 5-hour storage experiments (416 +/- 52 mm Hg vs 406 +/- 59 mm Hg in controls [p = NS] and vs 239 +/- 34 mm Hg in Wallwork [p < 0.05 vs the 2 other groups]) and a smaller increase in pulmonary vascular resistance in the 12-hour storage experiments (10.2 +/- 4.1 mm Hg/mL/minute vs 3.2 +/- 1.1 mm Hg/mL/minute in controls [p = NS] and vs 23.1 +/- 4.3 mm Hg/mL/minute in Wallwork [p < 0.02 vs Celsior, p < 0.002 vs controls]). Survival was also longer in the 12-hour preserved Celsior group. Other end points were not significantly different between the two preservative solutions. CONCLUSION These data support the efficacy of Celsior as a flush-out and storage solution for pulmonary grafts. Given its previously documented ability to adequately preserve heart transplants, Celsior might provide a unified "solution" to thoracic organ preservation.
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Affiliation(s)
- L Xiong
- Department of Cardiovascular Surgery, Hôpital Lariboisière, Paris
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136
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Kevelaitis E, Nyborg NC, Menasché P. Coronary endothelial dysfunction of isolated hearts subjected to prolonged cold storage: patterns and contributing factors. J Heart Lung Transplant 1999; 18:239-47. [PMID: 10328150 DOI: 10.1016/s1053-2498(98)00042-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A key role of endothelial dysfunction in the pathogenesis of early low coronary flow of heart transplants and late cardiac allograft vasculopathy indicates the importance of optimal coronary endothelial preservation during cold heart storage. We designed this study to investigate the effect of prolonged cold storage on endothelial and smooth muscle function of proximal (epicardial) and distal (intramyocardial) coronary arteries. METHODS Four groups of isolated rat hearts were subjected to cold cardioplegic perfusion and immersed in storage medium at 4 degrees C. In groups 1, 2, and 3, hearts were perfused with and stored in Celsior solution for 10, 15, and 30 hours, respectively. In group 4, hearts were perfused with Plegisol and stored in saline for 15 hours. At the end of cold heart storage, arterial segments were taken from the proximal and distal parts of the left coronary artery and mounted on an isometric wire myograph for functional studies. In fifth group, proximal and distal segments of coronary artery isolated from fresh hearts were used as controls. At the end of control measurements, these vessels were used for storage in vitro at 4 degrees C for 15 hours in saline (group 5A) or Celsior (group 5B). RESULTS The endothelium-dependent relaxation to acetylcholine was reduced in distal coronary arteries in group 1, and in both proximal and distal coronary artery segments in groups 2, 3, 4, and 5A. Endothelial function was significantly more impaired in both proximal and distal coronary arteries in group 4, as compared with group 2. The impairment of relaxation to acetylcholine was more pronounced following cold storage of the heart than after a similarly long storage of the isolated vessels. The endothelium-independent relaxations to isoprenaline did not differ among all groups. The basal myogenic tone was increased in distal coronary arteries in group 1, and in both proximal and distal coronary arteries in groups 2, 3, 4, and 5A. The sensitivity to the vasoconstricting action of 5-hydroxytryptamine was increased in distal coronary arteries in group 2, and in both proximal and distal coronary arteries in groups 3, 4, and 5A. CONCLUSIONS Prolonged ischemic cold heart storage induces coronary endothelial dysfunction that is more pronounced in distal than in proximal arteries and is related to the duration of heart storage and the composition of storage medium.
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Affiliation(s)
- E Kevelaitis
- Department of Physiology, Medical University, Kaunas, Lithuania.
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137
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Wildhirt SM, Weis M, Schulze C, Conrad N, Rieder G, Boehm DH, Meiser B, Kornberg A, Reichenspurner H, von Scheidt W, Reichart B. Myocardial preservation in clinical cardiac transplantation. Transplant Proc 1999; 31:147-8. [PMID: 10083051 DOI: 10.1016/s0041-1345(98)01481-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S M Wildhirt
- Department of Cardiac Surgery, Ludwig-Maximilians University, Munich, Germany.
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Roberts RF, Nishanian GP, Carey JN, Sakamaki Y, Starnes VA, Barr ML. A comparison of the new preservation solution Celsior to Euro-Collins and University of Wisconsin solutions in lung reperfusion injury. Transplantation 1999; 67:152-5. [PMID: 9921812 DOI: 10.1097/00007890-199901150-00025] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The lung is particularly susceptible to reperfusion injury, both experimentally and clinically after transplantation. The extracellular-type preservation solution Celsior, which has been predominantly studied in cardiac preservation, has components designed to prevent cell swelling, free radical injury, energy depletion, and calcium overload. Using an isolated blood-perfused rat lung model, we investigated whether Celsior would decrease preservation injury and improve lung function after cold ischemic storage and reperfusion compared to Euro-Collins (EC) and University of Wisconsin (UW) solutions. METHODS Lewis rat lungs were isolated, flushed with the respective cold preservation solution, and then stored at 4 degrees C for 6 or 12 hr. After ischemic storage, the lung block was suspended from a force transducer, ventilated with 100% O2, and reperfused for 90 min with fresh blood via a cannula in the pulmonary artery. Lung compliance, alveolar-arterial oxygen difference, and outflow oxygen tension were all measured. The capillary filtration coefficient (Kf), a sensitive measure of changes in microvascular permeability, was determined. RESULTS For 6 hr of cold storage, lungs stored in Celsior had lower Kf values than those stored in EC, indicating decreased microvascular permeability. No other significant differences were noted between Celsior and EC or UW. For 12 hr of cold storage, Celsior provided increased oxygenation, decreased alveolar-arterial O2 differences, increased compliance, and decreased Kf values as compared to both EC and UW. CONCLUSIONS Celsior provides better lung preservation than EC or UW as demonstrated by increased oxygenation, decreased capillary permeability, and improved lung compliance, particularly at 12-hr storage times. These results are highly relevant, inasmuch as EC and UW are the most common clinically used lung preservation solutions. Further studies of Celsior in experimental and clinical lung transplantation, as well as in other solid organs, are indicated.
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Affiliation(s)
- R F Roberts
- Department of Surgery, University of Southern California School of Medicine and Children's Hospital, Los Angeles 90033, USA
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139
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Raposio E, Cella A, Panarese P, Nordström REA, Santi P. Power Boosting the Grafts in Hair Transplantation Surgery*. Dermatol Surg 1998. [DOI: 10.1111/j.1524-4725.1998.tb00012.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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140
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Kitahara AK, Suzuki Y, Zhan CW, Wada H, Nishimura Y. Evaluation of new improved solution containing trehalose in free skin flap storage. BRITISH JOURNAL OF PLASTIC SURGERY 1998; 51:118-21. [PMID: 9659114 DOI: 10.1054/bjps.1997.0129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND DATA In this study, we evaluated a new intracellular type (IT-K) solution containing trehalose in a rabbit free skin flap storage model. Trehalose is a nonreducing disaccharide that can stabilise cell membranes under various stressful conditions. MATERIAL AND METHOD Seventy-two free skin flaps of the ear of rabbits were preserved in Euro-Collins (EC) solution or in IT-K solution for 24, 48, and 72 h at 4 degrees C. After completion of preservation, these flaps were replanted to the other ear by microsurgical techniques. Viability study and photo documentation were performed daily for 7 days. Tissue specimens were taken 24 h after vascular anastomosis, fixed in 10% formaldehyde and stained with haematoxylin and eosin (HE). Survival rates were analysed by Fisher's exact test for comparison of the two experimental groups. Values of P < 0.05 were considered to be statistically significant. RESULTS After 7 days, a survival rate of 100% of flaps were observed in both solutions after 24 h of preservation. After preservation for 48 h in IT-K solution the survival rate was 100%. However, in EC solution survival decreased to 75% (9 of 12 preserved flaps survived). This difference increased to 33.3% (4 of 12 flaps) in EC solution and 91.6% (11 of 12 flaps) (P < 0.01) in IT-K solution when the flaps were stored for 72 h. Light microscopic examination also showed less damage in flaps preserved in IT-K solution than in these preserved in EC solution. CONCLUSION IT-K solution was superior to EC solution in the preservation of free skin flaps on rabbit ears when stored for 48 and 72 h.
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Affiliation(s)
- A K Kitahara
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Kyoto University, Japan
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141
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Minor T, Vollmar B, Menger M, Isselhard W. Cold preservation of the small intestine with the new Celsior-solution First experimental results. Transpl Int 1998. [DOI: 10.1111/j.1432-2277.1998.tb00953.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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142
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Baldan N, Toffano M, Cadrobbi R, Codello L, Calabrese F, Bacelle L, Rigotti P. Kidney preservation in pigs using celsior, a new organ preservation solution. Transplant Proc 1997; 29:3539-40. [PMID: 9414827 DOI: 10.1016/s0041-1345(97)01013-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- N Baldan
- Department of Istituto di Chirurgia, University of Padova, Italy
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143
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Meiser BM, von Scheidt W, Weis M, Böhm D, Kur F, Koglin J, Reichenspurner H, Uberfuhr P, Reichart B. [Heart transplantation--state of the art today]. Herz 1997; 22:237-52. [PMID: 9441155 DOI: 10.1007/bf03044252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In spite of pharmacological progress, end stage congestive heart failure is still associated with a decrease in quality and expectation of life. Heart transplantation remains the last therapeutic option for these patients. While the one year survival rate has increased over the last few years up to 84%, a major problem remains the significant lack of donors. Therefore, the criteria for the selection of candidates for cardiac transplantation have to be kept quite tight: Evidence of poor outcome without transplantation is associated with ejection fractions below 20 to 25%, cardiac indices less than 2.01/min/m2, left ventricular filling pressure above 20 mm Hg and a enddiastolic diameter of > 80 mm. There are, however, also quite important functional parameters indicating the need for heart transplantation, e.g. the maximal oxygene uptake being less than 10 ml/kg/min or below 50% of the age-appropriate value. Elevated pulmonary vascular resistance above 4 to 5 Wood units without a significant decrease during application of prostaglandin derivatives or inhalation of NO represents a contraindication for orthotopic heart transplantation; alternatively, a heterotopic transplantation can be considered. Since there is a significant shortage of suitable donor organs, the donor criteria have been broadened, e. g. the accepted donor age was increased to 60 years. Based on these extended criteria, a careful donor evaluation including cardiac history, cardiac examination, ECG and echocardiogram has to be performed. Coronary angiography in older donors is suggested, but in many cases not possible due to circumstances. Further precondition for a good graft function is a sophisticated donor management until the time of explantation. Hypovolemia and hypocalemia, hypothermia, hypoxia and rapid lost of circulating triiodothyronine (T3) have to be detected and balanced. The cardioplegic solution used might not only have an impact on the immediate postoperative performance of the graft, but also on the long term outcome, particularly with regard to graft vessel disease. There are generally two types of solutions: Those with intracellular and those with extracellular electrolyte concentrations. In addition, the potassium concentration might be of some importance. Potassium seems to damage endothelial cells and trigger subsequent immunological reactions. Therefore, high potassium concentrations in the cardioplegic solution might correlate with the incidence of graft vessel disease during the long term follow-up. The surgical technique for orthotopic heart transplantation developed at the beginning of the sixties by Lower and Shumway has been used unchanged for the last 30 years. The only alteration recently introduced is the separate direct anastomosis of the pulmonary and systemic veins in order to improve the atrial function. Until recently the commonly employed immunosuppressive strategy after heart transplantation consisted of the standard drugs cyclosporin, azathioprin and prednisolon. Some transplant-units use additionally induction therapy with antibody preparations. Many centers, however, abolished this regimen due to significant short and long term side effects. Promising new, more specific antibodies (which are chimerized or humanised) could revive the induction concept. The most thoroughly tested novel immunosuppressive agent is tacrolimus (FK506). It has been demonstrated to be 10 to 100 times more potent than cyclosporin A in in vitro and in vivo models. It binds to a different binding protein (FK-binding-protein) than cyclosporin (cyclophilin), but has a similar mechanism of action inhibiting the expression of T-cell-activator genes for certain cytokines. First non-randomised studies after heart transplantation performed at the University of Pittsburgh revealed that significantly more tacrolimus than cyclosporin patients were free of rejection. In order to confirm these observations, we performed a prospective randomised controlled clin
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Affiliation(s)
- B M Meiser
- Herzchirurgische Klinik, Klinikum Grosshadern der Ludwig-Maximilians-Universität München
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144
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Kevelaitis E, Nyborg NC, Menasché P. Protective effect of reduced glutathione on endothelial function of coronary arteries subjected to prolonged cold storage. Transplantation 1997; 64:660-3. [PMID: 9293885 DOI: 10.1097/00007890-199708270-00022] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Endothelial dysfunction can play a key role in early no reflow and late accelerated cardiac graft arteriosclerosis. We studied the direct effect of reduced glutathione (GSH) on the preservation of endothelial function of coronary arteries subjected to prolonged cold storage. METHODS Ring preparations were dissected from rat left coronary arteries and mounted on an isometric wire myograph. After control measurements, artery segments were exposed to 15 hr of hypothermic (+4 degrees C) incubation in either normal saline (group 1), GSH-free Celsior solution (a new heart preservation solution) (group 2), or Celsior solution with 3 mmol/L of GSH (group 3). RESULTS After storage, the basal tone was increased in groups 1 and 2, but it did not change in group 3. The endothelium-dependent relaxation to acetylcholine was reduced in groups 1 and 2, but it was not affected in group 3. The sensitivity to acetylcholine was decreased in group 1, and there were no changes in groups 2 and 3. CONCLUSIONS Our data suggest that fresh GSH in Celsior solution improves preservation of coronary endothelial function.
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Affiliation(s)
- E Kevelaitis
- Department of Human Physiology, Medical Academy, Kaunas, Lithuania
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Barr ML, Nishanian GP, Sakamaki Y, Carey JN, Chang J, Starnes VA. A new organ preservation solution, Celsior, is superior to Euro-Collins and University of Wisconsin solutions in decreasing lung reperfusion injury. Transplant Proc 1997; 29:1357-8. [PMID: 9123338 DOI: 10.1016/s0041-1345(96)00594-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M L Barr
- Division of Cardiothoracic Surgery, University of Southern California, Los Angeles 90033, USA
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146
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Chapter 1 Hypothermia in relation to the acceptable limits of ischemia for bloodless surgery. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/s1873-9792(96)80003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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147
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Masters TN, Robicsek F, Fokin AA, Cook JW, Gong G, Jenkins S, Rice H, Dobbins C, Parker R. Comparison of Intermittent Warm and Cold Blood Perfusion During Hypothermic Myocardial Preservation on Functional and Metabolic Recovery. Echocardiography 1985. [DOI: 10.1111/j.1540-8175.1985.tb01420.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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