Overview and Future Practice Patterns in Cardiac and Pulmonary Preservation

Conte, John V.; Baumgartner, William A.

doi:10.1111/j.1540-8191.2000.tb00449.x

Cited by 9 publications

(6 citation statements)

References 92 publications

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“…Prolonged graft ischemia results in unacceptable rates of primary graft failure and limits the optimal utilization of donor lungs (36). Despite years of study, the optimal regimen for lung preservation has not yet been developed (7,18). Most researchers have focused on maintenance of lung endothelial integrity as a goal of lung preservation (26).…”

Section: Discussionmentioning

confidence: 99%

Selected Contribution: Mechanisms that may stimulate the resolution of alveolar edema in the transplanted human lung

Ware

Fang

Wang

et al. 2002

Journal of Applied Physiology

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nary edema is common in organ donors and lung transplant recipients. Therefore, we assessed the responsiveness of human donor lungs to pharmacological agents that stimulate clearance of alveolar edema. Organ donors whose lungs were rejected for transplantation were studied. After resection, transport (4°C), and rewarming (37°C) of lungs, alveolar fluid clearance was measured with (n ϭ 8 donors) or without (n ϭ 23 donors) ␤-adrenergic stimulation. Terbutaline-stimulated clearance (10 Ϫ4 M) was higher than unstimulated clearance (7.1 Ϯ 1.3 vs. 4.8 Ϯ 2.4%/h, P Ͻ 0.01). Second, we determined whether medications given to the organ donor were associated with the extent of pulmonary edema or the rate of alveolar fluid clearance in the harvested lung. Preharvest administration of dopamine in low to moderate doses was associated with faster alveolar fluid clearance (r ϭ 0.62, P Ͻ 0.01). Preharvest administration of diuretics was associated with lower extravascular lung water-to-dry weight ratios. This study provides the first evidence that a ␤ 2-adrenergic agonist stimulates alveolar fluid clearance in the human donor lung. Aerosolized ␤ 2-adrenergic agonists may have therapeutic value for hastening the resolution of alveolar edema during the management of donors before resection of lungs for transplantation or in the posttransplant setting. pulmonary edema; ␤-agonist; alveolar epithelial fluid transport; alveolar epithelium; lung preservation PULMONARY EDEMA IS A COMMON problem in both organ donors and lung transplant recipients. In organ do-

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Section: Discussionmentioning

confidence: 99%

Selected Contribution: Mechanisms that may stimulate the resolution of alveolar edema in the transplanted human lung

Ware

Fang

Wang

et al. 2002

Journal of Applied Physiology

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“…This occurs mainly in postcapillary venules, increasing hydrostatic pressure, and favoring the formation of edema, which is facilitated by the increased capillary permeability caused by endothelial injury. ROS have a key role in the development of pulmonary injury (IR) [ 21 , 22 ], which is characterized by increases in ROS and other free radicals, with a crucial role in the sequence of events leading to lung failure [ 23 ].…”

Section: Oxidative Stress and Lung Ischemia-reperfusion Injurymentioning

confidence: 99%

Oxidative Stress and Lung Ischemia-Reperfusion Injury

Ferrari

Andrade

2015

Oxidative Medicine and Cellular Longevity

228

189

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Ischemia-reperfusion (IR) injury is directly related to the formation of reactive oxygen species (ROS), endothelial cell injury, increased vascular permeability, and the activation of neutrophils and platelets, cytokines, and the complement system. Several studies have confirmed the destructiveness of the toxic oxygen metabolites produced and their role in the pathophysiology of different processes, such as oxygen poisoning, inflammation, and ischemic injury. Due to the different degrees of tissue damage resulting from the process of ischemia and subsequent reperfusion, several studies in animal models have focused on the prevention of IR injury and methods of lung protection. Lung IR injury has clinical relevance in the setting of lung transplantation and cardiopulmonary bypass, for which the consequences of IR injury may be devastating in critically ill patients.

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“…Both intracellular and extracellular solutions also frequently contain additional additives included to counteract the negative effects of donor heart procurement and reperfusion, including osmotic agents, additional metabolic substrates, and antioxidants. Osmotic agents, also referred to as impermeants or colloids, are added to reduce cellular edema 11‐13 . Amino acids and glucose are added to serve as a substrate for anaerobic metabolism, which although greatly reduced still occurs 11,14,15 .…”

Section: Discussionmentioning

confidence: 99%

“…Antioxidants are added to many preservation solutions to prevent oxidative stress. These antioxidants such as superoxide dismutase, glutathione, allopurinol, and histidine act to prevent the formation or bind to free radicals produced during reperfusion 11,16.17 . Each of the solutions in this study contain a custom variety of additives.…”

Section: Discussionmentioning

confidence: 99%

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

Shaw

Lirette

Carter

et al. 2020

Clinical Transplantation

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Background: Few studies directly compare outcomes between the most commonly used preservation solutions in pediatric heart transplantation in a large cohort of recipients. The purpose of this study is to investigate the effect of cardiac preservation solution on survival in pediatric heart transplant recipients. Methods: The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from 01/2004-03/2018 for pediatric donor hearts. Saline, University of Wisconsin (UW), "cardioplegia," Celsior, and Custodiol preservation solutions were evaluated. The primary endpoints were recipient survival at 30 days, 1 year, and long term. Results: After exclusion criteria, 3012 recipients had preservation solution data available. The most common preservation solution used was UW in 1203 patients (40%), followed by Celsior in 542 (18%), cardioplegia in 461 (15%), saline in 408 (14%), and Custodiol in 398 (13%). Survival of recipients whose donor hearts were procured with UW was as follows: 97%-30 day, 92%-1 year; Celsior: 97%-30 day, 92%-1 year; cardioplegia: 97%-30 day, 91%-1 year; saline: 97%-30 day, 91%-1 year; and Custodiol: 96%-30 day and 92%-1 year. Analysis of Cox models for 30-day and long-term survival revealed no statistical differences when comparing UW to Celsior (p = .333), cardioplegia (p = .914), saline (p = .980), or Custodiol (p = .642) in adjusted models. Conclusions: There were no significant differences in 30-day or 1-year survival detected between commonly used preservation solutions in the pediatric heart transplant population.

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Overview and Future Practice Patterns in Cardiac and Pulmonary Preservation

Cited by 9 publications

References 92 publications

Selected Contribution: Mechanisms that may stimulate the resolution of alveolar edema in the transplanted human lung

Selected Contribution: Mechanisms that may stimulate the resolution of alveolar edema in the transplanted human lung

Oxidative Stress and Lung Ischemia-Reperfusion Injury

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

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