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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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Gohrbandt B, Avsar M, Warnecke G, Sommer SP, Haverich A, Strueber M. Initial topical cooling followed by backtable Celsior flush perfusion provides excellent early graft function in porcine single lung transplantation after 24 hours of cold ischemia. J Heart Lung Transplant 2013; 32:832-8. [PMID: 23856220 DOI: 10.1016/j.healun.2013.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/20/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Topical in situ cooling of the donor lungs is a prerequisite for procurement of non-heart-beating donor lungs and may be of interest for living related lung donation. METHODS Twenty-four single lung transplants were performed in 4 groups of Landrace pigs (6 per group). Control LPD, control Celsior and topical cooling in situ, followed by LPD (exLPD) or Celsior (exCel) ex situ flush, were employed. All lungs were perfused antegrade with 1 liter of solution at 4°C. Lungs were stored immersed in preservation solution for 24 hours at 4°C. After transplantation of the left lung, the right recipient bronchus and pulmonary artery were clamped. RESULTS Four of 6 animals each in the LPD and Celsior groups and all 6 animals in both the exLPD and the exCel groups survived the 7-hour reperfusion. The mean oxygenation index was favorably preserved in the exCel group at 7 hours after reperfusion (417 ± 81) over all other groups (LPD 341 ± 133, Celsior 387 ± 86, exLPD 327 ± 76; p < 0.0001). Pulmonary vascular resistance showed significantly lower values in the Celsior and exCel groups (LPD 1,310 ± 620, Celsior 584 ± 194, exLPD 1,035 ± 361, exCel 650 ± 116 dyn/s/cm(5) at 7 hours after reperfusion; p < 0.0001). Consistently, the wet-to-dry lung weight ratio also indicated beneficial graft protection in the exCel group (LPD 8.1 ± 0.8, Celsior 8.4 ± 0.8, exLPD 7.5 ± 1.0, exCel 3.1 ± 0.9; p < 0.0001). CONCLUSION Initial topical cooling followed by backtable perfusion is a sufficient technique for pulmonary graft preservation providing excellent post-transplant function. Celsior subsequent to in-situ topical cooling revealed the most beneficial results in this setting. This combined technique could advance non-heart-beating, living related lung lobe donation and, potentially, regular heart-beating lung donation.
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Affiliation(s)
- Bernhard Gohrbandt
- Hannover Thoracic Transplant Program, Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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van Egmond A, van der Keur C, Swings GMJS, van Beelen E, van Zijl L, Scherjon SA, Claas FHJ. Preservation of human placenta facilitates multicenter studies on the local immune response in normal and aberrant pregnancies. J Reprod Immunol 2013; 98:29-38. [PMID: 23623053 DOI: 10.1016/j.jri.2013.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/27/2013] [Accepted: 03/04/2013] [Indexed: 01/03/2023]
Abstract
Our standard procedure for phenotypic and functional analysis of immune cells present in the placenta is to isolate leukocytes from the decidua within five hours of the delivery. However, this results in logistical problems with deliveries at night, weekends or in other medical centers. Collecting placentas after complicated pregnancies is even more difficult owing to the low prevalence and the often unscheduled delivery. The aim was to investigate the possibility of preserving the human placenta before phenotypic and functional analysis of decidual lymphocytes. Placentas were obtained after uncomplicated pregnancy. The tissue was divided into two equal parts: decidual lymphocytes from one part were isolated within five hours according to our standard procedure, whereas the other part was preserved in either Celsior(®), a storage solution for solid organ preservation, or phosphate-buffered saline (PBS) for 24h at 4°C before isolation. Overall, the phenotype and functional capacity of decidual lymphocytes isolated within five hours was comparable to decidual lymphocytes isolated after 24-h preservation in Celsior(®) or PBS. Minor differences were found between decidual lymphocytes isolated within five hours and decidual lymphocytes isolated after 24-h preservation in Celsior(®). The results indicate that PBS is sufficient to preserve the placenta for 24h for phenotypical and functional studies. The ability to preserve the placenta will simplify the procedure for the isolation of decidual lymphocytes and makes it easier to analyze tissue from women who deliver during the night, at weekends or in other hospitals, and possibly even women with complicated pregnancies.
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Affiliation(s)
- A van Egmond
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
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Pancreas procurement and preservation for islet transplantation: personal considerations. J Transplant 2011; 2011:783168. [PMID: 21918716 PMCID: PMC3171759 DOI: 10.1155/2011/783168] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 06/29/2011] [Accepted: 07/13/2011] [Indexed: 12/14/2022] Open
Abstract
Pancreatic islet transplantation is a promising option for the treatment of type 1 diabetic patients. After the successful demonstration of the Edmonton protocol, islet transplantation has advanced significantly on several fronts, including improved pancreas procurement and preservation systems. Since we frequently use pancreata from donors after cardiac death in Japan,we have applied the in situ regional organ cooling system for pancreas procurement to reduce the warm ischemic time. To reduce the apoptosis of pancreatic tissue during cold preservation, we have applied the ductal injection of preservation solution. For pancreas preservation, we use modified Kyoto solution, which is advantageous at trypsin inhibition and less collagenase inhibition. In this paper, we show pancreas procurement and preservation in our group for islet transplantation.
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Hypothermic kidney preservation: a remembrance of the past in the future? Curr Opin Organ Transplant 2011; 16:162-8. [DOI: 10.1097/mot.0b013e3283446b07] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Antioxidant treatment during preservation of bovine ovaries increased the development potential of embryos. ZYGOTE 2010; 18:315-21. [DOI: 10.1017/s0967199409990384] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SummaryThe overnight preservation of bovine ovaries would be highly useful in the subsequent harvest of viable oocytes for reproductive study. The present study aimed to optimize conditions for overnight preservation of bovine ovaries by examining the effects of temperature, solution and supplementation. In Experiment 1, the rate of development to the blastocyst stage of oocytes derived from ovaries preserved at 15°C was higher than that at either 5 or 25°C (p < 0.05). In Experiment 2, the rate of development to the blastocyst stage of oocytes derived from ovaries preserved in University of Wisconsin solution was higher than when PBS or saline was used (p < 0.05). In Experiment 3, oocytes preserved in saline supplemented with 0.3 mM glutathione (GSH) exhibited an increase in the rate of blastocyst formation compared with oocytes supplemented with 0 or 3 mM GSH (p < 0.05). In Experiment 4, supplementation with 10 μM epigallocatechin gallate during ovary preservation increased the rate of blastocyst formation (p < 0.05). The blastocysts derived from ovaries stored in saline supplemented with GSH at 15°C for 24 h were shown to develop into normal offsprings following transfer to recipient heifers. Our studies indicate that bovine IVM/IVF embryos derived from ovaries preserved in saline supplemented with an antioxidant at 15°C for 24 h can successfully develop to the blastocyst stage and result in offspring.
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Su H, Guo TK, Ma YT, Hao XY, Li Y, Jiang L, Liu YL. Celsior solution versus University of Wisconsin solution in liver preservation for transplantation. Hippokratia 2010. [DOI: 10.1002/14651858.cd008301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- He Su
- The People's Hospital of Gansu Province; Dong Gang West Road No.160 Lanzhou City Gansu China 730000
| | - Tian Kang Guo
- The People's Hospital of Gansu Province; Dong Gang West Road No.160 Lanzhou City Gansu China 730000
| | - Yun Tao Ma
- The People's Hospital of Gansu Province; Dong Gang West Road No.160 Lanzhou City Gansu China 730000
| | - Xiang Yong Hao
- The People's Hospital of Gansu Province; Dong Gang West Road No.160 Lanzhou City Gansu China 730000
| | - Yuan Li
- The People's Hospital of Gansu Province; Dong Gang West Road No.160 Lanzhou City Gansu China 730000
| | - Lei Jiang
- Lanzhou University; Centre of Evidence Based Medicine; Don Gang West Rd No. 199 Lanzhou City Gansu China 730000
| | - Ya Li Liu
- Lanzhou University; Centre of Evidence Based Medicine; Don Gang West Rd No. 199 Lanzhou City Gansu China 730000
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Noguchi H, Naziruddin B, Onaca N, Jackson A, Shimoda M, Ikemoto T, Fujita Y, Kobayashi N, Levy MF, Matsumoto S. Comparison of modified Celsior solution and M-kyoto solution for pancreas preservation in human islet isolation. Cell Transplant 2010; 19:751-8. [PMID: 20955657 DOI: 10.3727/096368909x508852] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Since the successful demonstration of the Edmonton protocol, islet transplantation has advanced significantly on several fronts, including improved pancreas preservation systems. In this study, we evaluated two different types of organ preservation solutions for human islet isolation. Modified Celsior (Celsior solution with hydroxyethyl starch and nafamostat mesilate; HNC) solution and modified Kyoto (MK) solution were compared for pancreas preservation prior to islet isolation. Islet yield after purification was significantly higher in the MK group than in the HNC group (MK = 6186 ± 985 IE/g; HNC = 3091 ± 344 IE/g). The HNC group had a longer phase I period (digestion time), a higher volume of undigested tissue, and a higher percentage of embedded islets, suggesting that the solution may inhibit collagenase. However, there was no significant difference in ATP content in the pancreata or in the attainability of posttransplant normoglycemia in diabetic nude mice between the two groups, suggesting that the quality of islets was similar among the two groups. In conclusion, MK solution is better for pancreas preservation before islet isolation than HNC solution due to the higher percentage of islets that can be isolated from the donor pancreas. MK solution should be the solution of choice among the commercially available solutions for pancreatic islet isolation leading to transplantation.
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Affiliation(s)
- Hirofumi Noguchi
- Baylor All Saints Medical Center, Baylor Research Institute, Fort Worth, TX, USA.
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Ridgway D, Manas D, Shaw J, White S. Preservation of the donor pancreas for whole pancreas and islet transplantation. Clin Transplant 2010; 24:1-19. [DOI: 10.1111/j.1399-0012.2009.01151.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Ostróżka-Cieślik A, Dolińska B, Ryszka F. Influence of the selected antioxidants on the stability of the Celsior solution used for perfusion and organ preservation purposes. AAPS PharmSciTech 2009; 10:468-75. [PMID: 19381826 DOI: 10.1208/s12249-009-9232-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 03/17/2009] [Indexed: 11/30/2022] Open
Abstract
The purpose of the following research was to improve the original Celsior solution in order to obtain a higher degree of stability and effectiveness. The solution was modified by the addition of selected antioxidants such as vitamin C, cysteine, and fumaric acid in the following concentrations: 0.1, 0.3, and 0.5 mmol/l. The solution's stability was estimated using an accelerated stability test based on changes in histidine concentrations in the solution using Pauly's method for determining concentrations. Elevated temperatures, the factor accelerating substances' decomposition reaction rate, were used in the tests. The research was conducted at four temperatures at intervals of 10 degrees C: 60 +/- 0.2 degrees C, 70 +/- 0.2 degrees C, 80 +/- 0.2 degrees C, and 90 +/- 0.2 degrees C. It was stated that the studied substances' decomposition occurred in accordance with the equation for first-order reactions. The function of the logarithmic concentration (log%C) over time was revealed to be rectilinear. This dependence was used to determine the kinetics of decomposition reaction rate parameters (the rate constant of decomposition k, activation energy E (a), and frequency factor A). On the basis of these parameters, the stability of the modified solution was estimated at +5 degrees C. The results obtained show that the proposed antioxidants have a significant effect on lengthening the Celsior solution's stability. The best results were reached when combining two antioxidants: vitamin C and cysteine in 0.5 mmol/l concentrations. As a result, the Celsior solution's stability was lengthened from 22 to 299 days, which is 13.5 times. Vitamin C at a concentration of 0.5 mmol/l increased the solution's stability by 5.2 times (t(90) = 115 days), cysteine at a concentration of 0.5 mmol/l caused a 4.4 times stability increase (t(90) = 96 days), and fumaric acid at a concentration of 0.5 mmol/l extended the stability by 2.1 times (t(90) = 48 days) in relation to the original solution.
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Celsior Versus Wisconsin Solution in Pancreas Transplantation. Transplant Proc 2008; 40:3305-7. [DOI: 10.1016/j.transproceed.2008.05.080] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Accepted: 05/05/2008] [Indexed: 11/24/2022]
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Liu CC, Hsu PK, Huang WC, Huang MH, Hsu HS. Two-Layer Method (UW Solution/Perfluorochemical Plus O2) for Lung Preservation in Rat Lung Transplantation. Transplant Proc 2007; 39:3019-23. [DOI: 10.1016/j.transproceed.2007.06.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 04/23/2007] [Accepted: 06/21/2007] [Indexed: 11/26/2022]
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Hubert T, Gmyr V, Arnalsteen L, Jany T, Triponez F, Caiazzo R, Vandewalle B, Vantyghem MC, Kerr-Conte J, Pattou F. Influence of Preservation Solution on Human Islet Isolation Outcome. Transplantation 2007; 83:270-6. [PMID: 17297400 DOI: 10.1097/01.tp.0000251723.97483.16] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The influence of the preservation solution used for in situ perfusion of the donor and pancreas storage on islet isolation has received little attention. METHODS In this prospective controlled trial, we compared the outcome of human islet isolation from pancreata perfused with University of Wisconsin (UW) solution or Celsior, an alternative colloid-free extracellular solution. RESULTS At the 1-year interim analysis, the viability and insulin secretion of islets isolated from donors perfused with UW (n=19) or Celsior (n=5) were identical. However, total islet recovery (IEQ) and isolation yield (IEQ/g) were 1.8-fold and 2.1-fold inferior in the Celsior group (P<0.05 vs. UW). Overall, 13 (68%) of islet preparations were effectively transplanted from the UW group vs. none from the Celsior group (P=0.01). The clinical study was discontinued and the causes of these differences were further explored in the pig (n=14). In contrast to UW, Celsior induced cell swelling and pancreas edema after only four hours of cold storage. These abnormalities were delayed when the donor was perfused with Solution de Conservation d'Organes et de Tissus (SCOT), an extracellular solution containing polyethylene glycol. CONCLUSIONS Our results suggest that colloid-free preservation solutions might be suboptimal for pancreas perfusion and cold storage prior to islet isolation and transplantation. Because pancreata are now frequently recovered for islet transplantation, preliminary experimental and clinical data about islet isolation should be obtained prior to the routine implementation of new preservation solutions for abdominal perfusion during multiorgan recovery.
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Affiliation(s)
- Thomas Hubert
- Inserm U859, Diabetes Cell Therapy, Faculty of Medicine, Lille 2 University, Lille, France
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García-Gil FA, Arenas J, Güemes A, Esteban E, Tomé-Zelaya E, Lamata F, Sousa R, Jiménez A, Barrao ME, Serrano MT. Preservation of the liver graft with Celsior solution. Transplant Proc 2007; 38:2385-8. [PMID: 17097942 DOI: 10.1016/j.transproceed.2006.08.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We studied the evolution of the liver graft with preservation in Celsior (CS) compared with University of Wisconsin solution (UW). MATERIAL AND METHODS A randomized prospective clinical study in 80 liver transplants (OLTs) from May 2001 to October 2003, compared CS (group I; n = 40) and UW (group II; n = 40). The characteristics of the donors were homogeneous, with no significant differences in 15 variables. CS was perfused with 4 L through the aorta, 2 L through the portal vein, and 1 L, through the portal vein on the back table; and the UW, as 3 L, 2 L, and 1 L, respectively. All OLTs were performed using the piggyback technique. RESULTS Group I experienced reperfusion syndrome (n = 2; 5.9%), primary graft nonfunction (n = 0); vascular complications (n = 0); biliary anastomosis stenosis (n = 8; 22.9%), intensive care unit (ICU) days (n = 4.1 +/- 1), death within 30 days (n = 1; 3.1%). The patient and graft survivals at 1, 3, 6, 12, and 24 months were 93.7%, 93.7%, 90.2%, 85.7%, 85.7%, and 94.3%, 88.5%, 85.2%, 78%, 78%, respectively. For group II; the reperfusion syndrome occured in 6 patients (17.6%); primary graft nonfunction (n = 0); vascular complications (n = 0), biliary anastomosis stenosis (n = 3; 8.6%), ICU days (n = 4.9 +/- 2.4) and death within 30 days (n = 1; 3.1%); The patient and graft survival at 1, 3, 6, 12, and 24 months were 96.9%, 93.5%, 89.8%, 79.8%, 79.8% and 94.3%, 88.3%, 84.9%, 75.5%, 66.1%, respectively. CONCLUSIONS CS offers the similar safety to UW for preservation of liver grafts within these ischemia times.
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Affiliation(s)
- F A García-Gil
- Liver Transplant Unit, Hospital Clínico Universitario. "Lozano Blesa," Zaragoza, Spain.
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Panzera P, Greco L, Rotelli MT, Lavolpe V, Salerno AM, Gentile A, Catalano G, Cicco G, Memeo V. Effects of Preservation Solutions on Blood. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2006; 578:277-83. [PMID: 16927705 DOI: 10.1007/0-387-29540-2_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Piercarmine Panzera
- Centre of Research in Hemorheology, Microcirculation and Oxygen Transport, University of Bari
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Wittwer T, Franke UFW, Fehrenbach A, Ochs M, Sandhaus T, Schuette A, Richter S, Dreyer N, Knudsen L, Müller T, Schubert H, Richter J, Wahlers T. Experimental Lung Transplantation: Impact of Preservation Solution and Route of Delivery. J Heart Lung Transplant 2005; 24:1081-90. [PMID: 16102444 DOI: 10.1016/j.healun.2004.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Revised: 07/15/2004] [Accepted: 07/19/2004] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Optimal preservation of allograft integrity is essential to reduce post-ischemic organ dysfunction after lung transplantation. Retrograde organ preservation leads to homogeneous intrapulmonary distribution and eliminates intravascular thrombi. So far, no comparative studies exist with regard to preservation quality following retrograde preservation with Perfadex and Celsior after extended cold-ischemia intervals. METHODS In an in vivo pig model, 5 lungs each were preserved for 27 hours using antegrade or retrograde perfusion techniques with Celsior (Ce(ant)/CE(ret)) and Perfadex (PER(ant)/PER(ret)). After left lung transplantation and contralateral lung exclusion, hemodynamics, oxygenation and dynamic compliance were monitored for 6 hours and compared with sham-operated controls. Pulmonary edema was determined stereologically. Statistics consisted of analysis of variance (ANOVA) with repeated measures. RESULTS Mortality of all Celsior-protected lungs was 100% due to severe reperfusion injury with profound lung edema. In contrast, organ preservation with PER(ant) led to sufficient graft function without mortality. Preservation quality after retrograde administration of Perfadex resulted in optimized oxygenation capacity compared with PER(ant) (p = 0.046). Furthermore, intra-alveolar edema was reduced and generally comparable with sham controls. In general, retrograde preservation led to continuous washout of small blood and fibrin clots from the pulmonary capillary system. CONCLUSIONS Perfadex solution provided sufficient lung preservation for 27 hours of cold ischemia, and its retrograde application led to significant functional and histologic improvement compared with antegrade perfusion. In contrast, preservation with Celsior solution resulted in lethal post-ischemic outcome, regardless of the route of administration, and therefore must be considered unsuitable for extended lung procurement.
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Affiliation(s)
- Thorsten Wittwer
- Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller University, Jena, Germany.
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UW is superior to Celsior and HTK in the protection of human liver endothelial cells against preservation injury. Liver Transpl 2004; 10:1514-23. [PMID: 15558836 DOI: 10.1002/lt.20309] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Celsior solution (CS), a new preservation solution in thoracic organ transplantation, was evaluated for its efficacy in cold preservation of human liver endothelial cells (HLEC) and was compared to University of Wisconsin solution (UW) and histidine-tryptophan-ketoglutarate solution (HTK, Custodiol). HLEC cultures were preserved at 4 degrees C in CS, UW, and HTK, for 2, 6, 12, 24, and 48 hours, with 6 hours of reperfusion. Levels of lactate dehydrogenase (LDH), 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), and adenosine 5'-triphosphate (ATP) were measured after each interval of ischemia and the respective phase of reperfusion. Preservation injury of HLEC as measured by LDH release, intracellular ATP level, and MTT reduction were overall significantly (P <or= .01, P <or= .01, P < .05, respectively) lower in UW than in CS and HTK. CS demonstrates a modest superiority to HTK in HLEC preservation. Furthermore, cold preservation remains the main cause of preservation injury of HLEC regardless of the preservation solution used. Additionally, the maintenance of a high intracellular ATP level of HLEC after ischemia and reperfusion, as shown by UW, could be taken as a beneficial effect, particularly in long-term ischemia. In conclusion, our cell culture model reveals the order of efficacy to protect HLEC against preservation injury as: UW >> CS > HTK.
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Wittwer T, Franke U, Fehrenbach A, Meyer D, Sandhaus T, Pfeifer F, Dreyer N, Mueller T, Schubert H, Richter J, Wahlers T. Impact of retrograde graft preservation in perfadex-based experimental lung transplantation. J Surg Res 2004; 117:239-48. [PMID: 15047129 DOI: 10.1016/j.jss.2003.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Optimal preservation of postischemic organ function is a continuing challenge in clinical lung transplantation. Retrograde instillation of preservation solutions has theoretical advantages to achieve a homogeneous distribution in the lung due to perfusion of both the pulmonary and the bronchial circulation. Thus far, no systematic screening studies followed by in vivo large animal reevaluation including stereological analysis of intrapulmonary edema exist concerning the influence of retrograde preservation on postischemic lung function after preservation with low potassium dextran (LPD) solution (Perfadex). MATERIALS AND METHODS For initial screening in an extracorporeal rat model eight lungs, each, were preserved for 4 h using antegrade or retrograde preservation with LPD solution (Perfadex; PER(ant)/PER(ret)). Respiratory and hemodynamic results after reperfusion were compared to low-potassium Euro-Collins (LPEC). For systematic reevaluation, five pig lungs, each, were preserved correspondingly for 27 h, and results were compared to sham-operated control lungs. In both models, edema formation was quantified stereologically. Statistics comprised different ANOVA models. RESULTS In both models, use of PER(ret) resulted in significantly higher oxygenation capacity, lower inspiratory pressures, and lower amounts of intraalveolar edema as compared to PER(ant). Results of PER(ret) were not different from sham controls in the in vivo model; furthermore, a continuous retrograde elimination of blood clots from pulmonary microcirculation was noticed. CONCLUSIONS Retrograde application of LPD solution (Perfadex) results in significant functional and histological improvement as compared to antegrade perfusion. This innovative technique can be applied very easily in clinical practice and might be an ideal adjunct to further optimize the results after lung transplantation with LPD-based graft protection.
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Affiliation(s)
- Thorsten Wittwer
- Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller University, 07740 Jena, Germany.
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Cavallari A, Cillo U, Nardo B, Filipponi F, Gringeri E, Montalti R, Vistoli F, D'amico F, Faenza A, Mosca F, Vitale A, D'amico D. A multicenter pilot prospective study comparing Celsior and University of Wisconsin preserving solutions for use in liver transplantation. Liver Transpl 2003; 9:814-21. [PMID: 12884193 DOI: 10.1053/jlts.2003.50161] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary dysfunction (PDF) still occurs after orthotopic liver transplantation (OLT). Celsior solution (CS) might offer some advantages over the conventional University of Wisconsin (UW) solution for organ preservation, but to date, this has not been prospectively evaluated in the context of OLT. In this prospective, randomized, multicenter, pilot study, 215 potential liver donors were enrolled and randomized. In 42 cases, the livers were unsuitable for transplantation; therefore, 173 randomized livers ultimately were implanted after perfusion and cold preservation with CS (n = 83) or UW solution (n = 90). In accord with the indications of the CS manufacturing company, total CS infusion volume was 90 mL/kg, greater than that of UW solution (60 mL/kg). The main aim of the study is to compare the prevalence of PDF between the two groups. Donor and recipient variables were similar in the two groups. Episodes of PDF were numerically lower in the CS (2.4%) than UW group (7.8%), but the difference was not statistically significant. There was a trend toward a lesser need for early re-OLT (<30 days) in the CS group (P =.0507), but again, no statistically significant difference emerged. Overall and time-differentiated postoperative deaths also were similar. One-year actuarial patient (UW, 89% v CS, 87%) and graft (UW, 83% v CS, 85%) survival rates were similar. In conclusion, CS was similar to UW solution as a preservation solution in the clinical setting of OLT at the infusion volumes described, although some theoretical advantages of CS composition suggest that CS might prove a valid alternative to UW preservation solution in multiorgan harvesting, including the liver. A study on a larger patient basis is needed.
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Affiliation(s)
- Antonino Cavallari
- Dipartimento di Discipline Chirurgiche, Rianimatorie e dei Trapianti Policlinico S Orsola, University of Bologna, Italy
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Koike N, Takeyoshi I, Ohki S, Tsutsumi H, Matsumoto K, Morishita Y. The effect of short-term coronary perfusion using a perfusion apparatus on canine heart transplantation from non-heart-beating donors. J Heart Lung Transplant 2003; 22:810-7. [PMID: 12873550 DOI: 10.1016/s1053-2498(02)00650-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND We investigated the effects of briefly perfusing hearts from non-heart-beating donors (NHBDs) with a Celsior solution before cardiac transplantation. METHODS Donor hearts were left in situ for 20 minutes after cardiac arrest was induced by rapid exsanguination. Twelve donor-recipient pairs of mongrel dogs were divided into 2 groups, the simple immersion (SI, n = 6) group and the coronary perfusion (CP, n = 6) group. Both groups underwent coronary flushing with Celsior, after which hearts from the SI group were stored using simple immersion for 4 hours and hearts from the CP group underwent 1 hour of further perfusion followed by storage for 3 hours. Orthotopic transplantation was then performed. We measured cardiac output, end-systolic maximal elastance (E(max)), left ventricular pressure, and rate pressure product 1 and 2 hours after weaning from cardiopulmonary bypass (CPB). Two hours after weaning from CPB, the hearts were harvested for histopathologic study and to determine the percentage of water content. RESULTS The cardiac output (CO) recovery rate was significantly higher in the CP group than in the SI Group 1 hour after weaning from CPB (p < 0.05). The CO recovery rate, E(max), and rate pressure product were significantly higher and the percentage of water content was significantly lower in the CP group than in the SI Group 2 hours after weaning from CPB (p < 0.05). Histopathologic damage was more severe in the SI group. CONCLUSIONS The results of this study suggest that short-term coronary perfusion with a Celsior solution may be useful for heart transplantation from NHBDs.
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Affiliation(s)
- Norimasa Koike
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Gunma, Japan
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Janssen H, Janbetaen PH, Broelsch CE. Celsior solution compared with University of Wisconsin solution (UW) and histidine-tryptophan-ketoglutarate solution (HTK) in the protection of human hepatocytes against ischemia-reperfusion injury. Transpl Int 2003. [DOI: 10.1111/j.1432-2277.2003.tb00341.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paik HC, Hoffmann SC, Egan TM. Pulmonary preservation studies: effects on endothelial function and pulmonary adenine nucleotides. Transplantation 2003; 75:439-44. [PMID: 12605106 DOI: 10.1097/01.tp.0000045685.09601.9e] [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: 11/25/2022]
Abstract
BACKGROUND Lung transplantation is an effective therapy plagued by a high incidence of early graft dysfunction, in part because of reperfusion injury. The optimal preservation solution for lung transplantation is unknown. We performed experiments using an isolated perfused rat lung model to test the effect of lung preservation with three solutions commonly used in clinical practice. METHODS Lungs were retrieved from Sprague-Dawley rats and flushed with one of three solutions: modified Euro-Collins (MEC), University of Wisconsin (UW), or low potassium dextran and glucose (LPDG), then stored cold for varying periods before reperfusion with Earle's balanced salt solution using the isolated perfused rat lung model. Outcome measures were capillary filtration coefficient (Kfc), wet-to-dry weight ratio, and lung tissue levels of adenine nucleotides and cyclic AMP. RESULTS All lungs functioned well after 4 hr of storage. By 6 hr, UW-flushed lungs had a lower Kfc than LPDG-flushed lungs. After 8 hr of storage, only UW-flushed lungs had a measurable Kfc. Adenine nucleotide levels were higher in UW-flushed lungs after prolonged storage. Cyclic AMP levels correlated with Kfc in all groups. CONCLUSIONS Early changes in endothelial permeability seemed to be better attenuated in lungs flushed with UW compared with LPDG or MEC; this was associated with higher amounts of adenine nucleotides. MEC-flushed lungs failed earlier than LPDG-flushed or UW-flushed lungs. The content of the solution may be more important for lung preservation than whether the ionic composition is intracellular or extracellular.
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Affiliation(s)
- Hyo Chae Paik
- Kangnamku Dogokdong 146-92, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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de Perrot M, Liu M, Waddell TK, Keshavjee S. Ischemia-reperfusion-induced lung injury. Am J Respir Crit Care Med 2003; 167:490-511. [PMID: 12588712 DOI: 10.1164/rccm.200207-670so] [Citation(s) in RCA: 664] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ischemia-reperfusion-induced lung injury is characterized by nonspecific alveolar damage, lung edema, and hypoxemia occurring within 72 hours after lung transplantation. The most severe form may lead to primary graft failure and remains a significant cause of morbidity and mortality after lung transplantation. Over the past decade, better understanding of the mechanisms of ischemia-reperfusion injury, improvements in the technique of lung preservation, and the development of a new preservation solution specifically for the lung have been associated with a reduction in the incidence of primary graft failure from approximately 30 to 15% or less. Several strategies have also been introduced into clinical practice for the prevention and treatment of ischemia-reperfusion-induced lung injury with various degrees of success. However, only three randomized, double-blinded, placebo-controlled trials on ischemia-reperfusion-induced lung injury have been reported in the literature. In the future, the development of new agents and their application in prospective clinical trials are to be expected to prevent the occurrence of this potentially devastating complication and to further improve the success of lung transplantation.
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Affiliation(s)
- Marc de Perrot
- Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Abrahamse STL, Dinant S, Pfaffendorf M, van Gulik TM. In vitro function of porcine carotid arteries preserved in UW, HTK and Celsior solutions. Fundam Clin Pharmacol 2002; 16:503-11. [PMID: 12685509 DOI: 10.1046/j.1472-8206.2002.00112.x] [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: 11/20/2022]
Abstract
We compared the efficacy of histidine-tryptophan-ketoglutarate (HTK) and University of Wisconsin (UW) solution with Celsior solution using hypothermically-preserved porcine carotid arteries and studied the importance of different components of these solutions by preserving carotid arteries in modified HTK solutions. Excised carotid arteries were stored at 4 degrees C in 0.9% (w/v) NaCl, UW, HTK, Celsior, or a modified HTK solution for up to 14 days. Preservation-induced changes in smooth muscle cell and endothelial cell function were determined using an organ bath for isometric tension recording. Short-term preservation (1-3 days) in UW, HTK and Celsior did not significantly alter contractile and relaxation responses of arterial segments when compared to freshly-excised segments, but significantly impaired these responses in arterial segments stored in 0.9% (w/v) NaCl solution. Long-term hypothermic preservation of arterial segments (7 and 14 days) in 0.9% (w/v) NaCl and HTK solution almost completely abolished all responses, but only slightly reduced the responses of arterial segments stored in UW solution. Intermediate results were obtained for Celsior. Modifying HTK by replacement of chloride for sulfate and phosphate resulted in improved contractile and relaxation responses after long-term preservation. With respect to smooth muscle and endothelial function, UW is superior to HTK and Celsior and the absence of chloride or presence of sulfate and phosphate plays a relevant role in this in vitro model of hypothermic preservation of porcine carotid arteries.
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Affiliation(s)
- S T L Abrahamse
- Department of Surgery (Surgical Laboratory), Academic Medical Center, The University of Amsterdam, The Netherlands
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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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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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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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Thabut G, Vinatier I, Brugière O, Lesèche G, Loirat P, Bisson A, Marty J, Fournier M, Mal H. Influence of preservation solution on early graft failure in clinical lung transplantation. Am J Respir Crit Care Med 2001; 164:1204-8. [PMID: 11673210 DOI: 10.1164/ajrccm.164.7.2012135] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the influence of preservation solution type and extra- or intracellular composition on the occurrence of early graft dysfunction after clinical lung transplantation. For 170 patients who underwent a single (n = 124) or bilateral (n = 46) lung transplantation in two centers in Paris between 1988 and 1999, the preservation technique applied to the donor lung was single-flush perfusion of the pulmonary artery with one of several solutions of intracellular (Euro-Collins, n = 61; University of Wisconsin, n = 24) or extracellular composition (Cambridge, n = 64; Celsior, n = 21). The early postoperative outcome of these patients was reviewed. Reimplantation edema occurred in 48% of all patients, and the overall 1-mo survival rate was 84%. No significant difference in the incidence of edema, duration of mechanical ventilation, and 1-mo survival rate was observed between the four groups or between intra- and extracellular groups. After adjustment for graft ischemic time by means of multivariate analysis, the use of extracellular preservation fluid was associated with a lower incidence of reimplantation edema without effect on 1-mo mortality. Graft ischemic time was associated with both edema occurrence and 1-mo survival rate (p = 0.02 and p = 0.01, respectively). We conclude that extracellular-type solutions are associated with better lung preservation than intracellular-type solutions in clinical transplantation.
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Affiliation(s)
- G Thabut
- Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, Clichy, France
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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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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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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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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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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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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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Wittwer T, Fehrenbach A, Meyer D, Brandes H, Albes J, Richter J, Wahlers T. Retrograde flush perfusion with low-potassium solutions for improvement of experimental pulmonary preservation. J Heart Lung Transplant 2000; 19:976-83. [PMID: 11044693 DOI: 10.1016/s1053-2498(00)00189-3] [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: 10/18/2022] Open
Abstract
BACKGROUND Optimal preservation of post-ischemic organ function is a continuing challenge in clinical lung transplantation. Retrograde instillation of preservation solutions has the theoretic advantage of achieving homogeneous distribution in the lung because of perfusing both the pulmonary and the bronchial circulation. So far, we have seen no experimental studies that include stereologic analysis of intrapulmonary edema concerning the influence of retrograde preservation on post-ischemic lung function after preservation with Perfadex and Celsior. METHODS In an extracorporeal rat model, we perfused 8 lungs, each, using either antegrade or retrograde perfusion technique with Celsior (CE(ant)/CE(ret)) and Perfadex (PER(ant)/PER(ret)). Results were compared with low-potassium Euro-Collins. Post-ischemic lungs were reventilated and reperfused mechanically. We continuously monitored relative oxygenation capacity (ROC), pulmonary artery pressure, flush time, and wet/dry ratio. Furthermore, we used stereologic means to evaluate edema formation. Statistics comprised different analysis of variance models. RESULTS Relative oxygen capacity of CE(ant)-protected lungs was superior to that of PER(ant) preservation (p = 0.05). Use of PER(ret) resulted in significantly higher ROC as compared with PER(ant) (p < 0.001) and was comparable to results obtained with CE-preservation, which was not further improved with retrograde application. CONCLUSIONS Celsior provides better lung preservation than does Perfadex when administered antegradely. Retrograde application of Perfadex results in significant functional improvement as compared with antegrade perfusion, which reaches the standard of Celsior-protected organs. Additional in vivo experiments in combination with ultrastructural analysis are warranted to further evaluate retrograde delivery of preservation solutions, which could be used in clinical lung transplantation to further optimize current results.
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Affiliation(s)
- T Wittwer
- Department of Cardiac Surgery, Thoracic and Vascular Surgery, Friedrich-Schiller University, Jena, Germany.
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Fuckert O, Rauen U, De Groot H. A role for sodium in hypoxic but not in hypothermic injury to hepatocytes and LLC-PK1 cells. Transplantation 2000; 70:723-30. [PMID: 11003348 DOI: 10.1097/00007890-200009150-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypothermia is considered to be responsible for sodium influx during cold hypoxic incubation. However, we have previously shown that hypothermia alone leads to a pronounced decrease in cellular sodium content when liver endothelial cells or hepatocytes are incubated under such conditions. In the research described here, we therefore studied the effects of hypothermia and hypoxia, alone or combined, on cellular sodium homeostasis and assessed the role sodium plays in the pathogenesis of hypoxic and hypothermic injury to cultured liver and kidney cells. METHODS Isolated hepatocytes and LLC-PK1 cells were incubated in Krebs-Henseleit buffer or a sodium-free modification thereof under normoxic and hypoxic conditions at 4 degrees C as well as at 37 degrees C. Cytosolic sodium concentration was determined in isolated hepatocytes under both warm and cold conditions using digital fluorescence microscopy and the Na+-sensitive dye sodium-binding benzofuran isophthalate. RESULTS When hepatocytes were incubated under cold normoxic conditions the cellular sodium concentration decreased. However, it increased strongly under hypoxic conditions at 4 degrees C and at 37 degrees C. When either hepatocytes or LLC-PK1 cells were incubated under hypoxic conditions at 4 degrees C or 37 degrees C, sodium-free medium provided protection. In contrast, sodium-free medium did not alleviate the hypothermic injury observed when cells were incubated under cold normoxia. CONCLUSIONS The sodium influx observed during cold hypoxia is triggered by hypoxia and not by hypothermia. Sodium plays a prominent role in hypoxic injury to cultured liver and kidney cells, although hypothermic injury of these cells is independent of sodium homeostasis.
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Affiliation(s)
- O Fuckert
- Institut für Physiologische Chemie, Universitätsklinikum Essen, Germany
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Chien S, Zhang F, Niu W, Tseng MT, Gray L. Comparison of university of wisconsin, euro-collins, low-potassium dextran, and krebs-henseleit solutions for hypothermic lung preservation. J Thorac Cardiovasc Surg 2000; 119:921-30. [PMID: 10788813 DOI: 10.1016/s0022-5223(00)70087-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We sought to test the effectiveness of 4 different solutions for hypothermic rat lung preservation. METHODS One hundred ninety-two rats were used. The rats were divided into 4 groups, and University of Wisconsin, Euro-Collins, low-potassium dextran, or Krebs-Henseleit solution was used in each group. They were further divided into 6 subgroups of 8 rats each. The lungs were preserved at 4 degrees C for 0, 4, 6, 8, 12, or 24 hours, respectively, and lung function was studied by using a living rat perfusion model. RESULTS Pulmonary arterial flow decreased in each group after 4 to 6 hours of preservation; the low-potassium dextran group decreased the least and the Krebs-Henseleit group decreased the most. Pulmonary vascular resistance increased in each group after 6 hours of preservation; the Krebs-Henseleit group increased the most. Although airway pressure increased, static lung compliance and gas exchange capacity decreased after 8 hours of preservation; the Krebs-Henseleit group exhibited the worst values. Lung tissue wet/dry weight ratio increased gradually during preservation; the University of Wisconsin group exhibited the least increase. An ultrastructural study indicated the least morphologic changes in the low-potassium dextran group at 24 hours. CONCLUSIONS At 4 degrees C, all solutions preserved rat lungs for 4 hours with acceptable function. However, 6 hours of preservation resulted in damaged pulmonary function in some lungs, and this damage increased when preservation time was extended. The lungs preserved in low-potassium dextran solution had the best overall function, but the lungs preserved in University of Wisconsin solution had less edema.
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Affiliation(s)
- S Chien
- Jewish Hospital Cardiothoracic Surgical Research Institute, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville, Louisville, KY 40292, USA
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Abstract
Since the beginning of transplantation the search for optimal means of organ preservation has been ongoing. One of the major causes of death early following heart or lung transplantation is graft failure. Factors that play a role in this problem include recipient and donor issues, but clearly procurement techniques and preservation solutions are important. This article summarizes the history, current clinical practice, and research devoted to heart and lung preservation for transplantation.
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Affiliation(s)
- C B Huddleston
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
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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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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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