Influence of the selected antioxidants on the stability of the Celsior solution used for perfusion and organ preservation purposes

The Effect of Antioxidant Added to Preservation Solution on the Protection of Kidneys before Transplantation

Ischemia–reperfusion injury is a key clinical problem of transplantology. Current achievements in optimizing organ rinse solutions and storage techniques have significantly influenced the degree of graft damage and its survival after transplantation. In recent years, intensive research has been carried out to maintain the viability of tissues and organs outside the integral environment of the body. Innovative solutions for improving the biochemical functions of the stored organ have been developed. The article discusses directions for modifying preservation solutions with antioxidants. Clinical and experimental studies aimed at optimizing these fluids, as well as perfusion and organ preservation techniques, are presented.

The Effectiveness of Rinsing Organs With Selected Preservation Solutions Based on the Analysis of Their Physicochemical Parameters

BACKGROUND

One of the key elements of successful transplantation is effectively rinsing off the blood and preserving organs under controlled hypothermia. The aim of the study was to analyze the physicochemical parameters of Biolasol (Biochefa, Sosnowiec, Poland) and histidine-tryptophan-ketoglutarate (HTK) (Custodiol) solutions, which are recommended for perfusion and preservation of abdominal parenchymal organs.

METHODS

Biolasol and HTK solution were used for the study. The solutions were subjected to physicochemical analysis involving pH, density, osmolarity, viscosity, refractive index, zeta potential, hydrodynamic diameter, and rheological properties. Rheological parameters were associated with morphologic features of fluids.

RESULTS

HTK and Biolasol are non-Newtonian systems with pseudoplastic properties and yield stress. The solutions begin to flow under shear stress greater than the ultimate stress. In addition, a nonlinear relationship of their viscosity as a function of velocity gradient (shear rate) was observed.

CONCLUSIONS

The solutions reproduce blood properties, which leads to the conclusion about their effective filling of the vascular bed and high efficiency in organ rinsing.

Analysis of Interactions Between Components of Selected Solution for Organ Perfusion and Preservation

BACKGROUND

In the literature there is a great deal of information about the activity of liquid preservatives and the solutions used to modify them; however, there is no information about the possibility of interactions between them during multiorgan retrieval. The aim of the study was to analyze the possibility of reactions between the components of Biolasol and histidine-tryptophan-ketoglutarate (HTK). Biolasol is the first Polish liquid preservative intended for rinsing kidneys, livers, and pancreases by simple hypothermia. HTK is a cardioplegic fluid used in organ preservation of hearts, livers, kidneys, pancreases, and lungs.

METHODS

Biolasol and HTK solution were used for the tests. The preservatives were mixed together at 1:1, 0.25:0.75, and 0.75:0.25 ratios. The volume of mixtures to be analyzed was 500 mL. The prepared systems were stored in a refrigerator (4°C) protecting against light. The systems were subjected to physicochemical analysis involving pH, density, viscosity, buffer capacity, osmolarity, and absorbance measurements as well as visual and microscopic assessment at time intervals: immediately after mixing (t = 0) and after 12, 24, 48, and 72 hours.

RESULTS

The analysis suggests that interactions between solution components can occur and have a positive effect on storage time and effectiveness of organ rinsing.

CONCLUSIONS

The use of Biolasol and HTK in multiorgan retrieval is safe.

Influence of trace elements on stabilization of aqueous solutions of ascorbic acid

Together with vitamin C, zinc, selenium, manganese, and magnesium play a vital role in the preservation of organs scheduled for transplantation. In the present study, it is shown that addition of 1 mg/l of these elements influences the stability of 0.3 mM ascorbic acid solutions. The solution's stability was estimated using an accelerated stability test. The concentration of vitamin C was measured using a validated spectrophotometric method, which uses the reduction of 2,6-dichlorophenoloindophenol by ascorbic acid. Elevated temperatures, the factor accelerating substances' decomposition reaction rate, were used in the tests. The research was conducted at two temperatures at intervals of 10 °C: 80 ± 0.1 and 90 ± 0.1 °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 stabilization of vitamin C solutions was measured as the time in which 10 % of the substance decomposed at 20 and 0 °C. Addition of Se(IV) or Mg(II) ions significantly increase the stability of ascorbic acid solution (∼34 and ∼16 %, respectively), but Zn(II) causes a significant decrease in stability by ∼23 %. Addition of Mn(II) has no significant influence on vitamin C stability.

Organ storage with University of Wisconsin solution is associated with improved outcomes after orthotopic heart transplantation

BACKGROUND

Despite significant advances in cardiac allograft preservation, the optimal preservative solution is unknown. We evaluated the impact of the most commonly used solutions in the USA, the University of Wisconsin solution (UW) and Celsior solution (CS), on outcomes after orthotopic heart transplantation (OHT).

METHODS

We retrospectively reviewed adult OHT recipients in the United Network for Organ Sharing (UNOS) database. Primary stratification was by preservation solution. The primary end-point was short-term survival (30 days and 1 year). Secondary end-points included common post-operative complications. Subgroup analysis was performed in high-risk allografts (donor age >50 years or ischemic time >4 hours). Risk-adjusted multivariate Cox proportional hazard regression was used to assess survival.

RESULTS

From 2004 to 2009, 4,910 patients (3,107 UW and 1,803 CS) with sufficient preservation solution information for analysis underwent OHT. Baseline characteristics were well-matched between the two groups. UW was associated with a small but significantly improved survival compared with CS at 30 days (96.7% vs 95.4%, p = 0.02) and 1 year (89.6% vs 87.0%, p < 0.01). These survival differences persisted on multivariate analysis at 30 days (HR 1.47 [1.02 to 2.13], p < 0.05) and 1 year (HR 1.40 [1.14 to 1.73], p < 0.01). In the 1,455 patients with high-risk allografts, preservation with UW was associated with improved survival compared with CS at 30 days (94.3% vs 91.3%, p < 0.01) and at 1 year (84.2% vs 80.19%, p < 0.01), a difference that was significant according to multivariate Cox analysis at 30 days (HR 2.29 [1.39 to 3.76], p < 0.01) and 1 year (HR 1.61 [1.17 to 2.21], p < 0.01).

CONCLUSIONS

Preservation with UW solution is associated with improved short-term survival compared with CS. Patients undergoing OHT with high-risk allografts have a similar survival benefit.