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Kraft CJ, Namsrai BE, Tobolt D, Etheridge ML, Finger EB, Bischof JC. CPA toxicity screening of cryoprotective solutions in rat hearts. Cryobiology 2024; 114:104842. [PMID: 38158172 DOI: 10.1016/j.cryobiol.2023.104842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/21/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
In clinical practice, donor hearts are transported on ice prior to transplant and discarded if cold ischemia time exceeds ∼5 h. Methods to extend these preservation times are critically needed, and ideally, this storage time would extend indefinitely, enabling improved donor-to-patient matching, organ utilization, and immune tolerance induction protocols. Previously, we demonstrated successful vitrification and rewarming of whole rat hearts without ice formation by perfusion-loading a cryoprotective agent (CPA) solution prior to vitrification. However, these hearts did not recover any beating even in controls with CPA loading/unloading alone, which points to the chemical toxicity of the cryoprotective solution (VS55 in Euro-Collins carrier solution) as the likely culprit. To address this, we compared the toxicity of another established CPA cocktail (VEG) to VS55 using ex situ rat heart perfusion. The CPA exposure time was 150 min, and the normothermic assessment time was 60 min. Using Celsior as the carrier, we observed partial recovery of function (atria-only beating) for both VS55 and VEG. Upon further analysis, we found that the VEG CPA cocktail resulted in 50 % lower LDH release than VS55 (N = 4, p = 0.017), suggesting VEG has lower toxicity than VS55. Celsior was a better carrier solution than alternatives such as UW, as CPA + Celsior-treated hearts spent less time in cardiac arrest (N = 4, p = 0.029). While we showed substantial improvement in cardiac function after exposure to vitrifiable concentrations of CPA by improving both the CPA and carrier solution formulation, further improvements will be required before we achieve healthy cryopreserved organs for transplant.
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Affiliation(s)
- Casey J Kraft
- Department of Biomedical Engineering, University of Minnesota, USA
| | | | - Diane Tobolt
- Department of Surgery, University of Minnesota, USA
| | | | - Erik B Finger
- Department of Surgery, University of Minnesota, USA.
| | - John C Bischof
- Department of Biomedical Engineering, University of Minnesota, USA; Department of Mechanical Engineering, University of Minnesota, USA; Institute for Engineering in Medicine, University of Minnesota, USA.
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Carter KT, Lirette ST, Baran DA, Creswell LL, Panos AL, Cochran RP, Copeland JG, Copeland H. The Effect of Cardiac Preservation Solutions on Heart Transplant Survival. J Surg Res 2019; 242:157-165. [DOI: 10.1016/j.jss.2019.04.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/25/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
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Baron O, Fabre S, Haloun A, Treilhaud M, al Habasch O, Duveau D, Michaud JL, Despins P. Retrospective Clinical Comparison of Celsior Solution to Modified Blood Wallwork Solution in Lung Transplantation for Cystic Fibrosis. Prog Transplant 2016; 12:176-80. [PMID: 12371042 DOI: 10.1177/152692480201200304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective To compare the preservative effects of Celsior solution and modified blood Wallwork solution in lung transplantation. Methods From 1989 to 2000, 44 lung transplantations for cystic fibrosis were performed: 26 grafts were preserved with modified blood Wallwork solution and 18 with Celsior solution. Results Preoperative status of the 2 groups was similar. The ratio of arterial oxygen to fraction of inspired oxygen and the pulmonary vascular resistance on the first postoperative day did not differ significantly between the 2 groups. Early death was 4% (SD, 20%) in the Wallwork group versus 11% (SD, 32%) in the Celsior group (not significant). No death was related to graft failure. The forced expiratory volume in 1 second during the first month after transplantation was 63% (SD, 19%) in the Wallwork group versus 63% (SD, 16%) in the Celsior group (not significant). Conclusion Because the solution does not need to be prepared on site and does not require blood from the donor, Celsior seems better than Wallwork solution for preserving lung grafts.
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Affiliation(s)
- O Baron
- Thoracic Transplantation Unit, Cardiovascular Surgery Department, Laennec Hospital, Nantes, France
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4
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Current state of pancreas preservation and implications for DCD pancreas transplantation. Transplantation 2013; 95:1419-24. [PMID: 23579769 DOI: 10.1097/tp.0b013e318285558f] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
One of the main factors limiting potential uptake of pancreas transplantation, particularly in the United Kingdom, is the shortage of grafts. There has therefore been a recent expansion, particularly in the United Kingdom, in the utilization of grafts from donation after cardiac death (DCD) donors. These grafts are subjected to a greater ischemic insult and are arguably at higher risk of poor functional outcome. Although conventional preservation techniques may be adequate for donation after brain death (DBD) and low-risk DCD pancreases, as the number of DCD pancreas transplants increase and the threshold for rejecting organs decreases, the importance of optimal preservation techniques is going to increase. Over recent years, there have been significant advances in preservation techniques for DCD kidneys, improving the outcome of these marginal grafts. However, the use of such techniques for pancreas preservation is extremely limited and mainly historical. This overview describes the background and results of the established method of pancreas preservation for DBD, namely, cold static storage, and describes the use of the two-layer method. It also reviews pulsatile machine perfusion and normothermic perfusion for pancreas preservation techniques, which have shown promise in the preservation of DCD kidney grafts. The use of these techniques in pancreas preservation is predominantly historical but warrants reevaluation as to the feasibility of applying these techniques to DCD pancreas grafts not only for preservation but also for viability assessment. Further areas for development of pancreas preservation are discussed.
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Lee CY, Mangino MJ. Preservation methods for kidney and liver. Organogenesis 2012; 5:105-12. [PMID: 20046672 DOI: 10.4161/org.5.3.9582] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 07/20/2009] [Indexed: 02/06/2023] Open
Abstract
With the successful testing of the immunosuppressive effects of cyclosporine in transplant patients in 1978, the field of organ transplants began an exponential growth. With that, the field of organ preservation became increasingly important as the need to increase preservation time and improve graft function became paramount. However, for every patient that receives a transplanted organ, there are four more on the waiting list. In addition, a patient dies from the lack of a transplant almost every 1(1/2) hour. To alleviate this donor crisis, there is a need to expand the donor pool to marginal donor organs. The main reason these organs are underutilized is because the current method of static preservation, simple cold storage, is ineffective. This article will provide a general review of the methods of preservation including simple cold storage, hypothermic machine perfusion, normothermic machine perfusion, and oxygen persufflation. In addition, the article will provide a review of how these dynamic preservation methods have improved the recovery and preservation of marginal donor organs including Donation after Cardiac Death and Fatty livers.
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Affiliation(s)
- Charles Y Lee
- Department of Mechanical Engineering and Engineering Science; University of North Carolina; Charlotte, NC USA
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García-Gil FA, Serrano MT, Fuentes-Broto L, Arenas J, García JJ, Güemes A, Bernal V, Campillo A, Sostres C, Araiz JJ, Royo P, Simón MA. Celsior versus University of Wisconsin preserving solutions for liver transplantation: postreperfusion syndrome and outcome of a 5-year prospective randomized controlled study. World J Surg 2011; 35:1598-607. [PMID: 21487851 DOI: 10.1007/s00268-011-1078-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Celsior solution (CS) is a high-sodium, low-potassium, low-viscosity extracellular solution that has been used for liver graft preservation in recent years, although experience with it is still limited. We performed an open-label randomized active-controlled trial comparing CS with the University of Wisconsin solution (UW) for liver transplantation (LT), with a follow-up period of 5 years. METHODS Adult transplant recipients (n=102) were prospectively randomized to receive either CS (n=51) or UW (n=51). The two groups were comparable with respect to donor and recipient characteristics. The primary outcome measure was the incidence of postreperfusion syndrome (PRS). Secondary outcome measures included primary nonfunction (PNF) or primary dysfunction (PDF), liver retransplantation, and graft and patient survival. Other secondary outcome measures were days in the intensive care unit (ICU) and the rates of acute rejection, chronic rejection, infectious complications, postoperative reoperations, and vascular and biliary complications. RESULTS In all, 14 posttransplant variables revealed no significant differences between the groups. There were no cases of PNF or PDF. The incidence of PRS was 5.9% in the CS group and 21.6% in the UW group (P=0.041). After reperfusion, CS revealed greater control of serum potassium (P=0.015), magnesium levels (P=0.005), and plasma glucose (P=0.042) than UW. Respective patient survivals at 3, 12, and 60 months were 95.7, 87.2, and 82.0% for the CS group and 95.7, 83.3, and 66.6% for the UW group (P=0.123). CONCLUSIONS While retaining the same degree of safety and effectiveness as UW for LT, CS may yield postliver graft reperfusion benefits, as shown in this study by a significant reduction in the incidence of PRS and greater metabolic control.
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Affiliation(s)
- Francisco A García-Gil
- Department of Surgery, University of Zaragoza, Domingo Miral s/n, 50009, Zaragoza, Spain.
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Pradeau D, Stocco J, Chaumeil JC. [Solutions for organ preservation and other cardioplegic liquid formulations. Role of the hospital pharmacist]. ANNALES PHARMACEUTIQUES FRANÇAISES 2008; 66:1-18. [PMID: 18435981 DOI: 10.1016/j.pharma.2007.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2007] [Indexed: 11/19/2022]
Abstract
Solid organ transplantation is an increasing need and a well-established activity which requires maintaining the quality of the transplant from procurement through the entire, storage, transport and graft procedure. Solutions for organ preservation play a key role in this procedure, by minimizing the deleterious effects of both ischemia and reperfusion. As such, their qualitative and quantitative compositions have to be optimized and validated. The development strategy and formulations proposed for these solutions are analyzed in this review as well as the results of the clinical studies which have set up the relevant pharmacological and physicochemical criteria. The French regulatory status of these products is also discussed. A clear distinction has to be made between solutions for organ preservation which are classified as produits thérapeutiques annexes (therapeutic ancillary products) and cardioplegic liquid formulations which are considered as medicinal products and are subject to marketing approval. Finally, the roles of the hospital pharmacist in the evaluation, selection, purchase and proper use of these products are described.
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Affiliation(s)
- D Pradeau
- Laboratoire de développement analytique et galénique, Ageps, 7, rue du Fer à Moulin, 75221 Paris cedex 05, France.
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Pereda D, Castella M, Pomar JL, Cartaña R, Josa M, Barriuso C, Roman J, Mulet J. Elective cardiac surgery using Celsior or St. Thomas No. 2 solution: a prospective, single-center, randomized pilot study. Eur J Cardiothorac Surg 2007; 32:501-6. [PMID: 17604178 DOI: 10.1016/j.ejcts.2007.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 05/25/2007] [Accepted: 05/30/2007] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Celsior is a crystalloid solution specifically designed for solid-organ transplantation. Due to its advanced combination of solutes, we wanted to evaluate its safety, efficacy, and possible benefits when used as blood cardioplegia in elective cardiac surgery in a single-center, randomized, controlled clinical trial, comparing its performance with a well-established cardioplegic solution. METHODS Patients programmed for aortic valve replacement were randomized to receive either St. Thomas No. 2 or Celsior as blood cardioplegia with the same administration protocol. Intraoperative and postoperative variables concerning myocardial protection were registered and compared. RESULTS A total of 60 patients were enrolled and randomized (Celsior, 30; St. Thomas, 30). There were no significant differences in baseline and preoperative variables. Volume of cardioplegic solution, number of administrations needed and the amount of potassium added were similar in both groups. Patients in the Celsior group showed a higher incidence of spontaneous sinus rhythm after myocardial ischemia (77% vs 40%, p=0.004) and fewer patients required defibrillation (17% vs 43%, p=0.024) for ventricular reperfusion arrhythmias. Postoperatively, there were no significant differences in troponin I release, inotropic and vasopressor drug support, ICU stay, and postoperative evolution. There were no deaths in the study. CONCLUSIONS Celsior solution used as blood cardioplegia is effective and seems to be safe in elective aortic valve replacement when compared in this pilot study with a standard cardioplegic solution used worldwide. Fast return to sinus rhythm and lower incidence of reperfusion arrhythmias in the Celsior group may reflect a better myocardial protection during cardioplegic arrest. More investigation is needed to elucidate its performance in elective surgery.
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Affiliation(s)
- Daniel Pereda
- Department of Cardiovascular Surgery, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
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Collins MJ, Ozeki T, Zhuo J, Gu J, Gullapalli R, Pierson RN, Griffith BP, Fedak PWM, Poston RS. Use of diffusion tensor imaging to predict myocardial viability after warm global ischemia: possible avenue for use of non-beating donor hearts. J Heart Lung Transplant 2007; 26:376-83. [PMID: 17403480 DOI: 10.1016/j.healun.2006.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 11/10/2006] [Accepted: 12/12/2006] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The assessment of myocardial viability after global warm ischemia (WI) but before reperfusion is challenging. We hypothesized that fractional anisotropy (FA), a magnetic resonance imaging (MRI) parameter of water diffusion that characterizes cellular integrity within tissues, provides a rapid and useful method for evaluating the viability of hearts after WI. METHODS Dog hearts were exposed to 60 minutes of WI after exanguination, explanted and preserved in a cold, non-beating state for 6 hours, using continuous perfusion (CP) or static cold storage (CS). Toward the end of preservation, a global FA assessment, acquired using MRI, was compared with analyses obtained from myocardial biopsies that included adenosine triphosphate (ATP), endothelin-1 (ET-1) and caspase-3 levels, light microscopy and tetrazolium staining. Functional recovery was analyzed after restoration of blood flow on a non-working Langendorff preparation. RESULTS FA measured at the end of CP showed strong correlations with all parameters of functional recovery (developed pressure, R = 0.60; dP/dt, R = 0.96; -dP/dt, R = 0.96). Although FA also correlated with tissue levels of ATP, ET-1 and caspase-3 (R = 0.77, -0.84, -0.64), recovery of myocardial function did not correlate with these markers or any other conventional analyses of myocardial injury (troponin I, changes on light microscopy or tetrazolium staining). CONCLUSIONS FA, an MRI-based parameter that indicates cellular integrity, was found to reflect better myocardial ATP stores, less induction of ET-1 and caspase-3 and improved functional recovery of hearts after global WI. As a clinically applicable tool capable of rapidly differentiating reversible from lethal injury, diffusion tensor imaging may prove useful in the eventual adoption of non-beating donor hearts for transplantation.
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Affiliation(s)
- Michael J Collins
- Division of Cardiac Surgery, Department of Surgery, University of Maryland Medical System, Baltimore, Maryland 21201, USA
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Manrique A, Jiménez C, Herrero ML, Meneu JC, Abradelo M, Moreno A, González E, Hernández E, Morales JM, Andrés A, Cortina J, Moreno E. Pancreas preservation with the University of Wisconsin versus Celsior solutions. Transplant Proc 2007; 38:2582-4. [PMID: 17098009 DOI: 10.1016/j.transproceed.2006.08.058] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The use of Celsior solution for organ preservation has not been thoroughly studied in pancreas transplantation. The aim of this study was to compare University of Wisconsin and Celsior solutions for preservation of pancreas grafts. PATIENTS AND METHODS From March 1995 to December 2005, 72 patients with type 1 diabetes underwent pancreas transplantation. There were 42 men and 30 women, with a mean age at transplantation of 38.1 +/- 7.5 years (range: 27 to 55 years), and a mean duration of diabetes of 22.5 +/- 6.6 years. Recipients were classified into two groups according to the preservation solution: (A) Celsior (n = 28, 38.9%) and (B) Wisconsin (n = 44, 61.1%). RESULTS The donor and recipient characteristics were similar in both groups. There were five cases of venous thrombosis in the Wisconsin group and two in the Celsior group (P = NS). The venous drainage technique in the former group was portocaval in 19 patients and portoiliac in 25; in the Celsior group, portocaval in 23 patients and portoiliac in five (P = .001). Enteric drainage was used in 19 patients from the Celsior group and 17 patients from the Wisconsin group (P = .01). Actuarial 2-year graft survival was 74.6% in the Wisconsin group and 77.4% in the Celsior group (P = NS). CONCLUSIONS No differences were observed in venous thrombosis between the two groups. The lower rate of venous thrombosis with the portocaval technique was related to the type of venous drainage rather than the type of preservation solution. Celsior solution may be considered as good as Wisconsin solution for pancreas transplantation.
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Affiliation(s)
- A Manrique
- Servicio de Cirugía General, Ap Digestivo y Trasplante de Organos Abdominales, Hospital Universitario Doce de Octubre, Madrid, Spain.
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Ozeki T, Kwon MH, Gu J, Collins MJ, Brassil JM, Miller MB, Gullapalli RP, Zhuo J, Pierson RN, Griffith BP, Poston RS. Heart Preservation Using Continuous Ex Vivo Perfusion Improves Viability and Functional Recovery. Circ J 2007; 71:153-9. [PMID: 17186994 DOI: 10.1253/circj.71.153] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cold static storage (CS) is a proven preservation method for heart transplantion, yet early postoperative graft dysfunction remains prevalent, so continuous perfusion (CP) during ex vivo transport may improve viability and function of heart grafts. METHODS AND RESULTS Canine hearts underwent CP (n=9) or CS (n=9) for 6 h while intramyocardial pH was continuously monitored. Biopsies were assayed for ATP, caspase-3, malondialdehyde (MDA), and endothelin-1 (ET-1) levels at baseline, after preservation (t1), and after 1 h of blood reperfusion on a Langendorff model (t2). Functional recovery was determined at t2 by +dP/dt, -dP/dt, developed pressure, peak pressure and end-diastolic pressure. CP resulted in higher tissue pH and ATP stores and reduced caspase-3, MDA and ET-1 levels compared with CS at both t1 and t2. Post reperfusion recovery was significantly greater in CP vs CS for all myocardial functional parameters except end-diastolic pressure. Weight gain was significantly increased in CP vs CS at t1, but not at t2. CONCLUSIONS Low-grade tissue acidosis and energy depletion occur during CS and are associated with oxidative injury and apoptosis during reperfusion. CP attenuates these biochemical and pathologic manifestations of tissue injury, together with improved myocardial recovery, despite mild, transient edema.
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Affiliation(s)
- Toshinaga Ozeki
- Division of Cardiac Surgery, University of Maryland School of Medicine and VA Medical Center at Baltimore 21201, USA
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Bastiaanse J, Slaaf DW, oude Egbrink MGA, Boeckx WD, Kon M. Do preservation solutions protect rat cremaster microcirculation during ischemia and reperfusion? J Surg Res 2005; 125:182-8. [PMID: 15854672 DOI: 10.1016/j.jss.2004.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 11/29/2004] [Accepted: 11/30/2004] [Indexed: 12/27/2022]
Abstract
BACKGROUND Our aim was to investigate the potential of the preservation solution Celsior to protect rat cremaster muscle microcirculation during ischemia and reperfusion, and to compare its effects with those of HTK (histidine-tryptophan-ketoglutarate-Bretschneider solution). Because of its anti-oxidant contents, we expected Celsior to be more protective than HTK. MATERIALS AND METHODS Capillary perfusion and leukocyte-endothelium interactions were examined in rat cremaster muscle using intravital microscopy. After perfusion with Celsior or HTK (4 degrees C), the cremaster was subjected to 4 or 6 h of warm (33-34 degrees C) ischemia and 2 h of reperfusion. Measurements were performed prior to perfusion and/or ischemia, and 0, 1, and 2 h after restoration of flow. RESULTS Without Celsior or HTK, capillary perfusion transiently decreased to 50% of baseline after 4 h of ischemia; it remained low (45%) after 6 h of ischemia. Whereas HTK had no significant influence, Celsior deteriorated capillary perfusion: it remained low after 4 h of ischemia (39-48%) and decreased even further after 6 h of ischemia (18-8%). Both preservation solutions similarly reduced the increase in leukocyte-endothelium interactions after ischemia. CONCLUSIONS Preischemic tissue perfusion with Celsior had an adverse effect on capillary perfusion in rat cremaster muscle after 4 and 6 h of ischemia, whereas HTK did not significantly influence this parameter. Both preservation solutions similarly prevented the increase in leukocyte-endothelium interactions after ischemia. These data suggest that HTK is more suited as a preservation solution for muscular tissue than Celsior, especially when the known protective effects of HTK on muscle function are taken into account.
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Affiliation(s)
- Jacqueline Bastiaanse
- Department of Plastic, Reconstructive & Hand Surgery, Utrecht University Medical Center, Utrecht, the Netherlands.
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Boggi U, Signori S, Vistoli F, Del Chiaro M, Pietrabissa A, Croce C, Barsotti M, Bartolo TV, Amorese G, Capocasale E, Della Valle R, Mazzoni MP, Mosca F. University of Wisconsion Solution Versus Celsior Solution in Clinical Pancreas Transplantation. Transplant Proc 2005; 37:1262-4. [PMID: 15848689 DOI: 10.1016/j.transproceed.2005.01.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study compared the safety and efficacy of University of Wisconsin solution (UW) and Celsior solution (C) in pancreas transplantation (PTx). METHODS A retrospective review of 154 PTx performed over a 61-month period included 77 grafts preserved with UW and 77 with C. The two groups were comparable for both donor and recipient characteristics. RESULTS After a mean cold ischemia time of 624 minutes (range 360 to 945 minutes) for UW versus 672 minutes (range 415 to 1005 minutes) for C (P = NS), no primary endocrine nonfunction occurred. Delayed endocrine function was diagnosed in two grafts in the UW group (2.6%) versus none in the C group (P = NS). After a minimum follow-up of 4 months (mean 26.5 +/- 15.2 months), 22 recipients (UW = 11 vs C = 11; P = NS) required relaparotomy. Overall, 18 pancreata were lost due to either patient death with functioning graft (UW = 4 vs C = 1; P = NS) or graft loss due to other reasons (UW = 8 vs C = 5; P = NS). Actuarial 1- and 5-year patient survival rates were 93.5% and 86.8% for UW compared with 98.7% and 98.7% for C (P = .04). Actuarial graft survival rates at the same times were 88.3% and 75.0% for UW compared with 90.4% and 90.4% for C (P = NS). CONCLUSIONS Within the range of cold ischemia times reported in this study, UW and C show similar safety and efficacy profiles for PTx.
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Affiliation(s)
- U Boggi
- Centro Regionale di Riferimento per la Cura delle Malattie del Pancreas, University of Pisa, Pisa, Italy
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Boggi U, Coletti L, Vistoli F, Del Chiaro M, Signori S, Croce C, Bartolo TV, Pietrabissa A, Marchetti P, Capocasale E, Dalla Valle R, Mazzoni MP, Mosca F. Pancreas preservation with University of Wisconsin and Celsior solutions. Transplant Proc 2004; 36:563-5. [PMID: 15110594 DOI: 10.1016/j.transproceed.2004.03.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the use of Celsior has been recently described for heart, lung, liver, and kidney transplantation, no data are available on its use for clinical pancreas preservation. METHODS We herein describe the results of 112 pancreas transplants preserved with either University of Wisconsin (UW; (n = 56) or Celsior (n = 56) solution at two Italian transplant centers. The groups were comparable with regard to all donor and recipient characteristics. RESULTS Mean cold and warm ischemia times were 10.1 +/- 2.2 hours and 37.2 +/- 8.2 minutes for UW compared to 10.8 +/- 2.4 hours and 38.3 +/- 6.7 minutes for Celsior (P = NS). Delayed endocrine pancreas function was recorded in two UW-preserved grafts (3.6%). Actuarial 1-year patient survival was 94.6% for UW as compared with 100% for Celsior (P = NS). Equivalent graft survival figures were 91.0% for UW as compared with 96.4% for Celsior (P = NS). CONCLUSIONS Within the range of cold ischemia times reported in this study, UW and Celsior solutions have similar safety profiles for pancreas transplantation.
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Affiliation(s)
- U Boggi
- Divisione di Chirurgia Generale e Trapianti, Università di Pisa, Pisa, Italy
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15
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Boggi U, Vistoli F, Del Chiaro M, Signori S, Croce C, Pietrabissa A, Berchiolli R, Marchetti P, Del Prato S, Mosca F. Pancreas preservation with University of Wisconsin and Celsior solutions: a single-center, prospective, randomized pilot study. Transplantation 2004; 77:1186-90. [PMID: 15114082 DOI: 10.1097/01.tp.0000120535.89925.ca] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Celsior is an extracellular-type, low-viscosity, preservation solution already used for heart, lung, liver, and kidney transplantation. We report the results of a single-center, prospective, randomized pilot study specifically designed to compare the safety profile of Celsior solution with University of Wisconsin (UW) solution in clinical pancreas transplantation. METHODS A total of 105 consecutive procurements were randomized to graft preservation with UW (n=53) solution or Celsior (n=52) solution. The groups were comparable with regard to all donor and recipient characteristics. RESULTS Five grafts were discarded and 100 grafts (50 UW vs. 50 Celsior) were transplanted. Mean cold and warm ischemia times were 11.0 +/- 2.1 hr and 37.2 +/- 6.0 min for UW compared with 10.8 +/- 1.8 hr and 38.1 +/- 5.9 min for Celsior (P =not significant). Delayed endocrine pancreas function was recorded in one graft preserved with UW solution. Eleven recipients (UW 12% vs. Celsior 10%, P =not significant) required a relaparotomy. The mean serum levels of glucose, amylase, and lipase remained comparable between the study arms at equivalent intervals after transplantation. One recipient died with functioning grafts in each study arm; two further grafts were lost to arterial thrombosis (Celsior) and chronic rejection (UW), respectively. Actuarial 1-year patient and graft survival rates overlapped in the two study arms (98% and 96%, respectively). CONCLUSIONS Within the range of cold ischemia time reported in this study, UW and Celsior solutions have similar safety profiles for pancreas preservation.
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Affiliation(s)
- Ugo Boggi
- Divisione di Chirurgia Generale e Trapianti, Dipartimento di Oncologia, Trapianti e Nuove Tecnologie in Medicina, Università di Pisa, Pisa, Italy.
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16
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McCrystal GD, Pepe S, Esmore DS, Rosenfeldt FL. The Challenge of Improving Donor Heart Preservation. Heart Lung Circ 2004; 13:74-83. [PMID: 16352173 DOI: 10.1016/j.hlc.2004.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Heart transplantation has in recent years become the treatment of choice for end stage heart failure. However while the waiting list for transplantation is growing steadily, the donor pool is not increasing. Therefore, in order to meet demand, transplant programs are using older, "marginal donors" and accepting longer ischaemic times for their donor hearts. As donor organs are injured as a consequence of brain death, during the period of donor management, at organ harvest, preservation, implantation and reperfusion, expansion of acceptance criteria places a great burden on achieving optimal long-term outcomes. However, at each step in the process of transplantation strategies can be employed to reduce the injury suffered by the donor organs. In this review, we set out what steps can be taken to improve the quality of donor organs.
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Affiliation(s)
- Graham D McCrystal
- Cardiac Surgical Research Unit, CJOB Department of Cardiothoracic Surgery, The Alfred Hospital and the Baker Heart Research Institute (Wynn Domain), Monash University, P.O. Box 6492, St. Kilda Rd. Central, Melbourne 8008, Vic., Australia
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17
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Baron O, Fabre S, Haloun A, Treilhaud M, al Habasch O, Duveau D, Michaud JL, Despins P. Retrospective clinical comparison of Celsior solution to modified blood Wallwork solution in lung transplantation for cystic fibrosis. Prog Transplant 2002. [PMID: 12371042 DOI: 10.7182/prtr.12.3.g2g0678241r53637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the preservative effects of Celsior solution and modified blood Wallwork solution in lung transplantation. METHODS From 1989 to 2000, 44 lung transplantations for cystic fibrosis were performed: 26 grafts were preserved with modified blood Wallwork solution and 18 with Celsior solution. RESULTS Preoperative status of the 2 groups was similar. The ratio of arterial oxygen to fraction of inspired oxygen and the pulmonary vascular resistance on the first postoperative day did not differ significantly between the 2 groups. Early death was 4% (SD, 20%) in the Wallwork group versus 11% (SD, 32%) in the Celsior group (not significant). No death was related to graft failure. The forced expiratory volume in 1 second during the first month after transplantation was 63% (SD, 19%) in the Wallwork group versus 63% (SD, 16%) in the Celsior group (not significant). CONCLUSION Because the solution does not need to be prepared on site and does not require blood from the donor, Celsior seems better than Wallwork solution for preserving lung grafts.
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Affiliation(s)
- O Baron
- Thoracic Transplantation Unit, Cardiovascular Surgery Department, Laennec Hospital, Nantes, France
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18
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Ackemann J, Gross W, Mory M, Schaefer M, Gebhard MM. Celsior versus custodiol: early postischemic recovery after cardioplegia and ischemia at 5 degrees C. Ann Thorac Surg 2002; 74:522-9. [PMID: 12173839 DOI: 10.1016/s0003-4975(02)03675-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this experimental study was to compare the protective efficacy of the cardioplegic solutions Celsior and Custodiol. Canine hearts were examined with regard to energy metabolism and early postischemic recovery after 8 or 12 hours of ischemia at 5 degrees C. METHODS Canine hearts were preserved with Celsior or Custodiol (each n = 19). Five hearts of each group were used to determine myocardial content of energy-rich phosphates immediately after preservation and after 8 and 12 hours of ischemia at 5 degrees C; the remainder were reperfused after 8 and 12 hours of ischemia. Control variables during reperfusion were myocardial content of energy-rich phosphates, myocardial K+ uptake, left ventricular dP/dtmax and dP/dtmin, and incidence of arrhythmias in percentage of heart rate. RESULTS Custodiol-preserved hearts contained more ATP than Celsior-preserved hearts after 8 and 12 hours of ischemia (8 hours p = ns, 12 hours, p < 0.05). During reperfusion after 8 hours of ischemia, dP/dtmax and dP/dtmin showed the same values for both solutions, after 12 hours values were significantly higher in Custodiol-preserved hearts (p < 0.005). The incidence of reperfusion arrhythmias was higher in hearts of the Celsior group (8 hours p < 0.01, 12 hours p = ns). Myocardial K+ uptake during reperfusion after 8 and 12 hours of ischemia was about twice as high in Celsior-preserved compared to Custodiol-preserved hearts (p < 0.005). CONCLUSIONS In the Langendorff model of the canine heart, cardioplegia with Celsior showed no advantage over cardioplegia with Custodiol. Differences were observed, however, which may be clinically important, especially in the case of long cold-storage times.
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Affiliation(s)
- Juergen Ackemann
- Department of Experimental Surgery, University Hospital, Heidelberg, Germany.
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19
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Uhlmann D, Armann B, Ludwig S, Escher E, Pietsch UC, Tannapfel A, Teupser D, Hauss J, Witzigmann H. Comparison of Celsior and UW solution in experimental pancreas preservation. J Surg Res 2002; 105:173-80. [PMID: 12121704 DOI: 10.1006/jsre.2002.6408] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The University of Wisconsin solution (UW) is the gold standard for pancreas preservation. Celsior (CEL) was formulated specifically for heart preservation. Recently, experimental and clinical experience has been reported on the application of CEL to abdominal organs. In this animal study, pancreas preservation with CEL was compared with that in UW solution. PATIENTS AND MATERIALS Heterotopic, allogeneic pancreaticoduodenal transplantation was performed in female Göttingen Minipigs (n = 12 donors, n = 12 recipients). The grafts were flushed and stored for 6 h at 4 degrees C in UW or CEL. The recipients were randomized into two groups receiving either UW (n = 6)- or CEL (n = 6)-preserved grafts with a follow-up of 5 days. Blood flow (laser Doppler), partial oxygen tension, histological changes, endothelin-1 (plasma, immunohistochemistry), lipase, amylase, trypsinogen activation peptide, and C-reactive protein (CRP) were measured. RESULTS Partial oxygen tension was lower in the CEL group (P < 0.05). However, blood flow did not differ between UW- and CEL-preserved organs. The histomorphologic analysis of the pancreatic grafts revealed significantly less edema in the UW-preserved organs. Serum levels of amylase, lipase, CRP, and TAP taken from the central venous blood were comparable in the two groups, except for higher amylase values 36 h after reperfusion in the CEL group compared to the UW group (P < 0.05). Likewise, TAP taken from the portal venous effluent of the graft was found to be higher in the CEL group than in UW (P < 0.05). Endothelin-1 serum levels rose significantly during reperfusion without differences between the two groups. ET-1 immunohistochemistry revealed increased local ET-1 during reperfusion in all grafts. However, the ET-1 immunostaining in the CEL group was more pronounced than that in the UW group (P < 0.05). CONCLUSIONS Our results suggest that CEL solution is not as effective in preventing pancreatic ischemia/reperfusion damage as the standard UW solution in experimental pancreas transplantation. Increased ET-1 immunostaining and reduced p(ti)O(2) in the CEL group indicate increased microcirculatory damage in the CEL group.
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Affiliation(s)
- Dirk Uhlmann
- 2nd Department of Surgery, University of Leipzig, 04103 Leipzig, Germany
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20
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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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21
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Donor organ preservation effects on the recipient. Curr Opin Organ Transplant 2002. [DOI: 10.1097/00075200-200203000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Marinello E, Tabucchi A, Rosi F, Gerunda G, Merenda R, Ballarin R, Neri D, Carlucci F. Organ preservation during experimental liver transplantation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2002; 486:369-72. [PMID: 11783517 DOI: 10.1007/0-306-46843-3_70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- E Marinello
- Institute of Biochemistry and Enzymology, University of Siena, Italy
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23
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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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24
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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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Howden BO, Jablonski P. Liver preservation: a comparison of celsior to colloid-free University of Wisconsin solution. Transplantation 2000; 70:1140-2. [PMID: 11063330 DOI: 10.1097/00007890-200010270-00002] [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: 01/16/2023]
Abstract
INTRODUCTION Celsior (CEL) was formulated specifically for heart preservation. Recently some preliminary reports have suggested that CEL is also effective for liver preservation. In this study liver preservation with CEL was compared to colloid-free University of Wisconsin solution (MUW). METHODS Arterialized rat liver isografts were flushed and stored for 24 hr at 0 degrees C in CEL or MUW before orthotopic transplantation. Plasma albumin, bilirubin, glucose, aspartate aminotransferase, and alkaline phosphatase were measured 1, 2, 3, 7, 14, 21, and 28 days after surgery. RESULTS All recipients of MUW-preserved livers survived, none of the recipients of CEL-preserved grafts lived beyond 3 days. On day 1, AST was raised in all rats but rats receiving CEL-preserved liver grafts were also markedly hypoglycemic, hypoalbuminemic and had elevated alkaline phosphatase. CONCLUSION Celsior is not an effective solution for long-term liver preservation in its present composition.
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Affiliation(s)
- B O Howden
- Monash University, Department of Surgery, Monash Medical Centre, Melbourne, Australia
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26
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Hoenicke EM, Peterseim DS, Ducko CT, Sun X, Damiano RJ. Donor heart preservation with the potassium channel opener pinacidil: comparison with University of Wisconsin and St. Thomas' solution. J Heart Lung Transplant 2000; 19:286-97. [PMID: 10713254 DOI: 10.1016/s1053-2498(99)00138-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hyperpolarized arrest with the potassium channel opener pinacidil has been shown to provide effective myocardial protection during short-term global ischemia. This study tested the hypothesis that pinacidil may provide effective long-term protection for heart transplant preservation. METHODS Four concentrations of pinacidil (50 microM, 100 microM, 0.5 mM, 1.0 mM) mixed in Krebs-Henseleit solution were compared with University of Wisconsin and St. Thomas' Hospital solutions in a Krebs-Henseleit perfused rabbit Langendorff model (n = 6 for each group). Hearts underwent 4 hours of hypothermic (4 degrees C) storage. Over a wide range of volumes, left ventricular systolic function, diastolic compliance, and coronary flow were measured prior to and following storage. Time to mechanical and electrical arrest, and post-ischemic percent tissue water were also measured. RESULTS Pinacidil 0.5 mM provided the best preservation of post-ischemic systolic function and coronary flow compared with the other pinacidil concentrations and was statistically equivalent to St. Thomas' solution in terms of post-ischemic systolic, diastolic, and flow properties. However, hearts protected with University of Wisconsin solution had significantly better preservation of systolic function and coronary flow. CONCLUSIONS This investigation demonstrated that pinacidil in Krebs-Henseleit solution possesses efficacy in long-term donor heart preservation. Pinacidil was equivalent to St. Thomas' solution but inferior to University of Wisconsin solution. Hyperpolarized arrest with potassium channel openers may be a novel strategy to improve donor heart preservation.
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Affiliation(s)
- E M Hoenicke
- Penn State Geisinger Health System, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
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Gnaiger E, Kuznetsov AV, Königsrainer A, Margreiter R. Autooxidation of glutathione in organ preservation solutions. Transplant Proc 2000; 32:14. [PMID: 10700947 DOI: 10.1016/s0041-1345(99)00857-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E Gnaiger
- Department of Transplant Surgery, D. Swarovski Research Laboratory, University Hospital Innsbruck, Austria
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Kirklin JK, McGiffin DC. Control of the inflammatory response in extended myocardial preservation of the donor heart. Ann Thorac Surg 1999; 68:1978-82. [PMID: 10585115 DOI: 10.1016/s0003-4975(99)01016-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The damaging effects of inflammation after prolonged myocardial ischemia are typically manifest during the period of reperfusion. The imbalance between free radical generation and availability of natural free radical scavengers during postischemic reperfusion set the stage for free radical injury. Calcium overload may convert reversible ischemic damage to fatal myocyte contracture. Complement activation and neutrophil activation, adhesion, and diapedesis are central components of the damaging inflammatory response. Cytokines such as tumor necrosis factor and IL1 simulate IL8 synthesis which is also a potent chemoattractant for neutrophils. The endothelial contribution to ischemic-reperfusion injury results from an imbalance between the production of naturally occurring vasodilators, such as prostacycline and nitric oxide, and vasoconstrictor products, such as endothelin, thromboxane A2, and angiotensin 2. Knowledge of these basic mechanisms has stimulated the formulation of preservation solutions and strategies to ameliorate the inflammatory response during reperfusion.
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Affiliation(s)
- J K Kirklin
- Department of Surgery, University of Alabama at Birmingham, 35294, USA.
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Wieselthaler GM, Chevtchik O, Konetschny R, Moidl R, Mallinger R, Mares P, Griessmacher A, Grimm M, Wolner E, Laufer G. Improved graft function using a new myocardial preservation solution: Celsior. Preliminary data from a randomized prospective study. Transplant Proc 1999; 31:2067-8. [PMID: 10455971 DOI: 10.1016/s0041-1345(99)00264-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G M Wieselthaler
- Department of Cardiothoracic Surgery, University of Vienna, Austria
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30
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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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31
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Süzer O, Köseoğlu S, Han G. No beneficial effects of isocolloidoosmotic synthetic colloid addition to St. Thomas Hospital cardioplegic solution in ischemia-reperfusion injury in isolated perfused rat hearts. GENERAL PHARMACOLOGY 1999; 32:101-5. [PMID: 9888261 DOI: 10.1016/s0306-3623(98)00091-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
1. Cardioplegic solutions provide the opportunity to operate on a nonbeating heart and to protect the heart against ischemic injury during cardiac surgery. The components of these solutions are constantly being modified in an effort to find the optimal solution. We studied the effects of colloidal volume replacers such as dextran, HES and gelatin as an isocolloidoosmotic addition to St. Thomas Hospital cardioplegic solution in ischemia-reperfusion injury of isolated rat hearts. 2. In the control group, after a stabilization period of 20 min, the hearts were arrested with St. Thomas Hospital cardioplegic solution for 3 min, then subjected to 30 min of global ischemia. Hearts then were reperfused for 10 min. In the experimental groups, the protocol was the same, but either HES 200/0.5 (50 g/L), modified fluid gelatin (30 g/l) or dextran 70 (25 g/L) were added to the St. Thomas Hospital solution. 3. All hearts were compared for their preischemic and postischemic contractility, heart rate, contractility rate product, coronary flow, lactate dehydrogenase, creatine phosphokinase enzyme leakage and wet/dry weight ratio. 4. All groups had similar contractility (for control, HES, gelatin and dextran groups the values at minute 10 of reperfusion were 59+/-9, 56+/-11%, 61+/-14%, 49+/-14% of initial values [P>0.05, respectively]) and enzyme leakage (lactate dehydrogenase 4.1+/-1.0, 8.1+/-1.5, 5.8+/-1.4, 3.7+/-1.2 [P>0.05] and for creatine phosphokinase 3.9+/-2.5, 6.4+/-3.7, 5.5+/-1.3, 5.5+/-0.8, P>0.05] IU xmin(-1) x g dry tissue(-1) in the reperfusion period, respectively) results as compared with the control group. 5. The addition of isocolloidoosmotic colloids to the cardioplegic solution did not appear to enhance the effectiveness of the crystalloid St. Thomas Hospital cardioplegic solution. If a colloid is to be chosen as a plasma replacer or an additive to priming solution in the preoperative period, or during open-heart surgery, it should be modified fluid gelatin-for no sign of cardiodepression was determined with the use of this agent.
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Affiliation(s)
- O Süzer
- Department of Pharmacology, Istanbul University, Cerrahpaşa Faculty of Medicine, Turkey.
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32
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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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Demmy TL, Biddle JS, Bennett LE, Walls JT, Schmaltz RA, Curtis JJ. Organ preservation solutions in heart transplantation--patterns of usage and related survival. Transplantation 1997; 63:262-9. [PMID: 9020328 DOI: 10.1097/00007890-199701270-00015] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite experimental advantages for certain heart preservation solutions (HPS), their clinical popularity and related survival are uncertain. We surveyed all active UNOS heart transplant centers to determine their HPS. HPS survival benefits were tested using the UNOS heart transplant registry. Centers used from 1 to 3 types of 167 solutions. Of these formulations, 55.1% were commonly cited solutions. The other (custom) mixtures differed from those usually reported. All solutions were classified as intracellular (I, [Na++] < 70 mEq/L) or extracellular (E, [Na++] > or = 70 mEq/L). Significant variations in solution usage were observed among major regions of U.S. transplant activity (Northeast [NE], Southeast [SE], and West [W], P < 0.001). For example, 62.5% of University of Wisconsin (UW) and 49.3% of "Other" usage occurred in the NE; 75% of Roe and 100% of Collins usage occurred in the SE; and 100% of Krebs and 46% of Stanford usage occurred in the W. Logistic regression analyses of 9401 patients who underwent transplantation from 10/87 to 12/92 showed a reduction in the adjusted one month mortality odds ratio for grafts preserved with I rather than E solutions (0.85, P < 0.05). Compared with the most commonly used solution, Plegisol (20.1% of cases), the following adjusted odds ratios for one-month mortality were observed: UW, 1.09 (ns); Stanford, 0.80 (P < 0.10); Roe, 0.36 (P < 0.001); Collins, 0.82 (ns); Krebs, 0.14 (P < 0.01). Using the same one month comparison with Plegisol, 16.8% of grafts that received Custom-I solutions also fared better (0.75, P < 0.05) than the 21.4% that had Custom-E mixtures (0.91, ns). HPS usage varies greatly and there are regional preferences. There may be early survival benefits for certain intracellular HPS--however, further study is warranted to explore such relationships.
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Affiliation(s)
- T L Demmy
- Division of Cardiothoracic Surgery, School of Medicine, University of Missouri-Columbia, 65212, USA
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Yamamasu S, Sato EF, Ogita S, Inoue M. Role of glutathione metabolism and apoptosis in the regression of liver hemopoiesis. Free Radic Biol Med 1997; 23:100-9. [PMID: 9165302 DOI: 10.1016/s0891-5849(96)00610-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although apoptosis has been believed to play important roles in ontogenic development of animals, the molecular mechanism that triggers the regression of liver hemopoiesis during perinatal period is not known. Apoptosis is induced by many factors, such as decrease in growth factors and increased oxygen stress. Because hepatic gamma-glutamyltransferase (GGT) changes markedly during the perinatal period of a rodent, metabolism of glutathione (GSH), a naturally occurring major antioxidant, might change significantly in and around liver cells. To know the possible involvement of apoptosis and GSH metabolism in the regression of hemopoiesis, hepatocytes and hemopoietic cells were isolated from fetal rat liver. Biochemical analysis revealed that, during the perinatal period, hepatic GGT levels transiently increased predominantly with hepatocytes, suggesting a marked change in thiol status in and around these cells. Cell culture analysis revealed that hemopoietic cells but not hepatocytes exhibited a marked apoptosis in a thiol-free medium, as judged from DNA fragmentation. The apoptosis of hemopoietic cells was inhibited by various thiols, such as L-cysteine, N-acetyl-L-cysteine (NAC), and GSH. These observations suggested that a marked change in GSH status in and around liver cells might play critical roles in triggering apoptosis of hemopoietic cells, thereby enhancing the regression of liver hemopoiesis.
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Affiliation(s)
- S Yamamasu
- Department of Biochemistry, Osaka City University Medical School, Japan
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Moghadasian MH, Godin DV. Species-related variations in antioxidant components of gastric and duodenal mucosa. Comp Biochem Physiol B Biochem Mol Biol 1995; 112:703-9. [PMID: 8590384 DOI: 10.1016/0305-0491(95)00124-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Enzymatic and non-enzymatic antioxidant profiles of the gastric and duodenal mucosa of rat, rabbit, cat and pig were investigated and found to exhibit significant variations. Rat gastric and duodenal mucosa exhibited the highest levels of basal glutathione of the various tissues examined. The highest activity of glutathione reductase was found in the gastric and duodenal mucosa of rat as compared with that in these tissues from the other species. The gastric mucosa of cat and pig showed similar activities of glutathione peroxidase, which was significantly lower than those in rat or rabbit gastric mucosa. The activity of this antioxidant enzyme was similar in rat, rabbit and pig duodenal mucosa and lower than that in cat duodenal mucosa. Strong correlations were found between activities of the functionally coupled antioxidant enzymes glutathione peroxidase and glutathione reductase in gastric but not in duodenal mucosa. The activity of superoxide dismutase showed negligible regional or species-related variations in activity.
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Affiliation(s)
- M H Moghadasian
- Department of Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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