A novel method of measuring cardiac preservation injury demonstrates University of Wisconsin solution is associated with less ischemic necrosis than Celsior in early cardiac allograft biopsy specimens

George, Timothy J.; Arnaoutakis, George J.; Beaty, Claude A.; Shah, Ashish S.; Conte, John V.; Halushka, Marc K.

doi:10.1016/j.healun.2011.11.023

Cited by 22 publications

(20 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although there may be some variability in the composition of individual centers’ solutions, the use of Celsior or cardioplege were both significant predictors of adverse recipient outcomes in our analysis compared to preservation with University of Wisconsin solution. Other studies have found similar interactions suggesting that the use of these solutions should be questioned during cardiac procurement (21, 22). Given that myocardial protection is paramount in the field of heart transplantation, further study into the biochemical interactions associated with each preservative solution as well as the development of new solutions will further delineate the optimal preservation strategy in order to minimize myocardial injury during organ transport.…”

Section: Discussionmentioning

confidence: 67%

Cardiac Donor Risk Factors Predictive of Short-Term Heart Transplant Recipient Mortality: An Analysis of the United Network for Organ Sharing Database

Sorabella

Guglielmetti

Kantor

et al. 2015

Transplantation Proceedings

View full text Add to dashboard Cite

Background To address the shortage of donor hearts for transplant, there is significant interest in liberalizing donor acceptance criteria. Therefore, the aim of this study is to evaluate cardiac donor characteristics from the United Network for Organ Sharing (UNOS) database to determine their impact on post-transplant recipient outcomes. Methods Adult (≥ 18 years) patients undergoing heart transplant from July 1, 2004 to December 31, 2012 in the UNOS Standard Transplant Analysis and Research (STAR) database were reviewed. Patients were stratified by 1-year post-transplant status; survivors (Group S, n=13,643) and patients who died or underwent cardiac re-transplant at 1-year follow-up (Group NS/R=1,785). Thirty-three specific donor variables were collected for each recipient, and independent donor predictors of recipient death or re-transplant at 1 year were determined using multivariable logistic regression analysis. Results Overall 1-year survival for the entire cohort was 88.4%. Mean donor age was 31.5 ± 11.9 years and 72% were male. On multivariable logistic regression analysis, donor age > 40 years (OR 1.44, 95% CI 1.27-1.64), graft ischemic time > 3 hours (OR 1.32, 1.16-1.51), and the use of cardioplege (OR 1.17, 1.01-1.35) or Celsior (OR 1.21, 1.06-1.38) preservative solution were significant predictors of recipient death or re-transplant at 1 year post-transplant. Male donor gender (OR 0.83, 0.74-0.93) and the use of antihypertensives (OR 0.88, 0.77-1.00) or insulin (OR 0.84, 0.76-0.94) were protective from adverse outcomes at 1-year. Conclusions These data suggest that donors who are older, female, or have a long projected ischemic time pose greater risk to heart transplant recipients in the short-term. Additionally, certain components of donor management protocols, including antihypertensive and insulin administration, may be protective to recipients.

show abstract

Section: Discussionmentioning

confidence: 67%

Cardiac Donor Risk Factors Predictive of Short-Term Heart Transplant Recipient Mortality: An Analysis of the United Network for Organ Sharing Database

Sorabella

Guglielmetti

Kantor

et al. 2015

Transplantation Proceedings

View full text Add to dashboard Cite

show abstract

“…Aside from preexisting PAH in the recipient, ischemia and reperfusion injury associated with organ preservation can also contribute to RVF after CTX. Various heart preservation solutions are commercially available, some of which may play a role in ischemia and right HF . Finally, longer cold ischemia time and advanced donor age can also lead to a weaker RV and increase the risk of postoperative failure …”

Section: Pathophysiologymentioning

confidence: 99%

Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular Dysfunction after Left Ventricular Assist Device Placement and Cardiac Transplantation

et al. 2017

View full text Add to dashboard Cite

Right ventricular failure (RVF) after cardiac transplant (CTX) or implantation of a continuous-flow left ventricular assist device (CF-LVAD) is associated with significant postoperative morbidity and mortality. A variety of modalities have been used to treat postoperative RVF, including management of volume status, intravenous inotropes and vasodilators, and right-sided mechanical support. Inhaled vasodilator agents are a unique treatment option aimed at minimizing systemic absorption by delivering therapy directly to the pulmonary vasculature. Current LVAD and CTX guidelines endorse inhaled vasodilators for managing postoperative RVF; however, no guidance is offered regarding agent selection, dosing, or administration. A review of the current literature confirms that inhaled pulmonary vasodilator agents have been shown to decrease pulmonary artery pressure when used in the perioperative period of CF-LVAD implant or CTX. However, the literature regarding the potential impact on clinical outcomes (e.g., survival or risk of developing RVF) is lacking with these medications. Based on our assessment of the literature, we suggest that when RVF occurs in the setting of a normal pulmonary vascular resistance (PVR), traditional inotropic therapy (e.g., dobutamine) should be used. Conversely, if the PVR is elevated (> 250 dynes/sec/cm 5 or 3 Wood units), or the patient has other evidence of a high right ventricular afterload (i.e., a transpulmonary gradient > 12 mm Hg), then an inhaled pulmonary vasodilator would be the preferred initial pharmacologic agent. Drug selection depends largely on the institution's capacity to safely prepare and administer the medication, along with formulary considerations, such as the high costs associated with inhaled iloprost and inhaled nitric oxide. KEY WORDS heart transplantation, left ventricular assist device, right heart failure, pulmonary arterial hypertension, inhaled pulmonary vasodilators. (Pharmacotherapy 2017;37(8):944-955)

show abstract

“…Compared with Celsior preservation solution, UW is associated with less ischemic necrosis in early cardiac allograft biopsies [89] and improved short-term outcomes [90]. UW was superior to histidine-tryptophan-ketoglutarate (HTK) solution after prolonged cold preservation of renal grafts [91] but inferior to Celsior in liver transplantation associated with more post-reperfusion syndrome [92].…”

Section: Clinical Applicationmentioning

confidence: 99%

The CD39-adenosinergic axis in the pathogenesis of renal ischemia–reperfusion injury

Roberts

Lü

Rajakumar

et al. 2012

Purinergic Signalling

View full text Add to dashboard Cite

Hypoxic injury occurs when the blood supply to an organ is interrupted; subsequent reperfusion halts ongoing ischemic damage but paradoxically leads to further inflammation. Together this is termed ischemia-reperfusion injury (IRI). IRI is inherent to organ transplantation and impacts both the short-and long-term outcomes of the transplanted organ. Activation of the purinergic signalling pathway is intrinsic to the pathogenesis of, and endogenous response to IRI. Therapies targeting the purinergic pathway in IRI are an attractive avenue for the improvement of transplant outcomes and the basis of ongoing research. This review aims to examine the role of adenosine receptor signalling and the ecto-nucleotidases, CD39 and CD73, in IRI, with a particular focus on renal IRI. Ischemia-reperfusion injury (IRI) is an obligatory insult in transplantation occurring at the time of organ procurement and engraftment. Ischemia is induced when blood flow to an organ is interrupted. Re-establishment of blood flow is essential to prevent ongoing hypoxic injury but paradoxically imparts further injury, termed IRI. Warm ischemia is relatively short in brain dead donors (<30 min); however, this can be prolonged in donors following cardiac arrest (up to 90 min). Furthermore, unique to transplantation is the period of cold preservation, which slows the cellular metabolic rate in order to minimize ongoing ischemic damage but which may be prolonged (extending to hours). The clinical ramifications of IRI include systemic inflammatory effects and organ dysfunction, increasing graft immunogenicity, the risk of delayed graft function, acute rejection, and chronic allograft dysfunction. There is substantial evidence implicating purinergic signalling in both the pathogenesis of and the endogenous response to IRI, and strategies targeting various aspects of the pathway may therefore be of therapeutic potential. ATP, present in relatively high concentrations intracellularly, is extruded from injured and necrotic cells into the extracellular space or released in a more controlled manner from apoptotic cells through pannexin hemi-channels and from inflammatory cells via connexin hemi-channels [1]. Upon release, extracellular ATP acts in an autocrine or paracrine manner on specific cell-surface P2 receptors belonging to two subclasses, the G protein-coupled P2Y receptors and the ATP-gated P2X nonselective cation channels [2]. ATP Keywords

show abstract

A novel method of measuring cardiac preservation injury demonstrates University of Wisconsin solution is associated with less ischemic necrosis than Celsior in early cardiac allograft biopsy specimens

Cited by 22 publications

References 12 publications

Cardiac Donor Risk Factors Predictive of Short-Term Heart Transplant Recipient Mortality: An Analysis of the United Network for Organ Sharing Database

Cardiac Donor Risk Factors Predictive of Short-Term Heart Transplant Recipient Mortality: An Analysis of the United Network for Organ Sharing Database

Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular Dysfunction after Left Ventricular Assist Device Placement and Cardiac Transplantation

The CD39-adenosinergic axis in the pathogenesis of renal ischemia–reperfusion injury

Contact Info

Product

Resources

About