Does pediatric heart transplant survival differ with various cardiac preservation solutions?

Association of cardiac preservation solution with short-term outcomes after heart transplantation

AIMS

There is wide variability in the practice of cardiac preservation for heart transplantation. Prior reports suggest that the type of solution may be linked with a reduced incidence of posttransplantation complications.

METHODS

Adult (≥18 years old) heart recipients who underwent transplantation between 2015 and 2021 in the United States were examined. Recipients were stratified by solution utilized for their grafts at the time of recovery: University of Wisconsin, histidine-tryptophan-ketoglutarate (HTK), or Celsior solution. The primary endpoint was a composite of 30-day mortality, primary graft dysfunction, or re-transplantation. Risk adjustment was performed for the recipient, donor, and procedural characteristics using regression modeling.

RESULTS

Among 16 884 recipients, the group distribution was University of Wisconsin solution 53%, HTK 22%, Celsior solution 15%, and other 10%. The observed incidence of the composite endpoint (University of Wisconsin solution = 3.6%, HTK = 4.0%, Celsior solution = 3.7%, P = 0.301) and 1-year survival (University of Wisconsin solution = 91.7%, HTK = 91.3%, Celsior solution = 91.7%, log-rank P = 0.777) were similar between groups. After adjustment, HTK was associated with a higher risk of the composite endpoint [odds ratio (OR) 1.249, 95% confidence interval (CI) 1.019-1.525, P = 0.030] in reference to University of Wisconsin solution. This association was substantially increased among recipients with ischemic periods of greater than 4 h (OR 1.817, 95% CI 1.188-2.730, P = 0.005). The risks were similar between University of Wisconsin solution and Celsior solution (P = 0.454).

CONCLUSION

The use of the histidine-tryptophan-ketoglutarate solution during cold static storage for cardiac preservation is associated with increased rates of early mortality or primary graft dysfunction. Clinician discretion should guide its use, especially when prolonged ischemic times (>4 h) are anticipated.

Nucleotide metabolism during experimental preservation for transplantation with Transmedium Transplant Fluid (TTF) in comparison to Histidine-Tryptophan-Ketoglutarate (HTK)

Organ preservation solutions are essential to diminish ischemic/hypoxic injury during cold storage and to improve graft survival. In our experiments, we investigated novel solutions that target such mechanisms as Transmedium Transplant Fluid (TTF) in comparison to PlegiStore solution (HTK). Rat hearts were infused with TTF or HTK and then subjected to 4 hours of 4 °C preservation followed by 25 minutes of reperfusion in the Langendorff system. Assessment of purine release from the heart, mechanical function, and cardiac nucleotide content in the heart homogenates was done. A significant increase in the uric acid, hypoxanthine, inosine, and total purine metabolite concentrations were observed in the HTK hearts when compared to TTF. The TTF group had lower left ventricular systolic pressure and left ventricular end-diastolic pressure when compared to the HTK. Left ventricular diastolic pressure, minimal dp/dt, and maximal dp/dt in both groups were similar. The concentration of ADP in the heart homogenates of the HTK group was increased when compared to the TTF group. ATP and GTP concentration showed a tendency to increase in the homogenates of TTF hearts when NAD, AMP, GDP, GMP, and ADPR were similar in both groups of rats. TTF provided enhanced cardioprotection as evidenced by inhibiting the purine nucleotide metabolites released from the rat hearts during reperfusion and enhanced systolic and diastolic mechanical function recovery. In particular, better preservation of GTP and ATP concentrations may translate into enhanced protection of endothelium and the cytoskeleton, which are not adequately protected with current preservation techniques.