The UW solution has greater potential for longer preservation periods than the Celsior solution: comparative study for ventricular and coronary endothelial function after 24-h heart preservation

Kajihara, Noriyoshi; Morita, Shigeki; Tanoue, Yoshihisa; Boku, Noriko; Eto, Masataka; Nishida, Takahiro; Tominaga, Ryuji

doi:10.1016/j.ejcts.2006.01.020

Cited by 24 publications

(14 citation statements)

References 21 publications

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“…4, 5 However, many clinicians and researchers are reticent to use such a high potassium solution, particularly with regard to its putative but controversial effect on coronary and pulmonary vascular endothelium. 2, 3, 8 …”

Section: Discussionmentioning

confidence: 99%

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

Arnaoutakis

Beaty

et al. 2012

The Journal of Heart and Lung Transplantation

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Purpose No consensus exists on the optimal heart preservative solution (HPS) for cardiac allograft preservation. The significance of varying degrees of acute ischemic necrosis (AIN) in early transplant biopsies is unknown. We investigated the effects of HPS on early cardiac histopathology by developing a novel grading system of AIN. Methods We retrospectively reviewed our institutional database of orthotopic heart transplants (OHT) identifying all hearts preserved with University of Wisconsin (UW) or Celsior (CS) solutions. A single blinded cardiovascular pathologist graded AIN severity on early post-transplant biopsies. Primary stratification was by HPS. Multivariable models examined mortality, AIN grade, primary graft dysfunction (PGD) and right heart failure (RHF). Results From 1996–2010, 174 adult OHT were preserved with UW (42) or CS (132) from which 431 biopsies were reviewed. UW and CS had similar 30-day (p=0.79) and 1-year mortality (p=0.92). CS was associated with significantly more AIN on the 1st (p=0.02) and 2nd (p=0.04) biopsies. This association persisted on multivariable analysis (1st biopsy OR: 2.93[1.26–6.83], p=0.01 and 2nd biopsy OR: 2.08[0.99–4.34], p=0.05). When stratified by AIN score, 30-day and 1-year mortality were similar (p>0.05). However, on adjusted analysis, increasing AIN score on the 1st biopsy was strongly associated with an increased incidence of PGD (OR: 1.59[1.02–2.47], p=0.04) and RHF (OR: 2.45[1.14–5.27], p=0.02). Conclusions Our novel grading system provides a simple, reproducible method for determining AIN. Preservation with UW is associated with less AIN than CS solution. Early biopsy ischemia is associated with primary graft dysfunction and right heart failure. AIN may have prognostic significance and its routine evaluation should be considered.

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Section: Discussionmentioning

confidence: 99%

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

Arnaoutakis

Beaty

et al. 2012

The Journal of Heart and Lung Transplantation

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“…In an experimental study from Kajihara et al. UW solution led to a better left ventricular function and a greater potential for long‐term preservation [20]. Furthermore, Michel et al.…”

Section: Discussionmentioning

confidence: 99%

“…In an experimental study from Kajihara et al UW solution led to a better left ventricular function and a greater potential for long-term preservation [20]. Furthermore, Michel et al showed in rat hearts that UW resulted in better heart contractility, lower LDH and CK levels during perfusion then HTK [21].…”

Section: Patients Survivalmentioning

confidence: 99%

Long-term outcomes after 1000 heart transplantations in six different eras of innovation in a single center

Kofler¹,

Bigdeli²,

Kaczmarek³

et al. 2009

Transplant International

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Summary The objective of this study was to evaluate long‐term outcomes of cardiac transplantation (HTx) in different eras of innovation at a single center during a period of 27 years. We performed a retrospective analysis of 960 cardiac allograft recipients (40 re‐HTx) between 1981 and 2008. The results of six different eras based on milestones in HTx were analysed: Era 1: the early years (n = 222, 1981–1992); era 2: introduction of inhalative nitric oxide, prostanoids, University of Wisconsin solution (UW) replacing Bretschneider’s solution (HTK, n = 118, 1992–1994); era 3: statins (n = 102, 1994–1995); era 4: tacrolimus (n = 115, 1995–1996); era 5: mycophenolate mofetil (MMF, n = 143, 1997–2000) and era 6: sirolimus (n = 300, 2000–2008). Outcome variables were survival, freedom from cardiac allograft vasculopathy (CAV) and from acute rejection episodes (AREs). Differences in survival was found comparing era 1 and era 2 with era 4 and era 6 (P < 0.001). Organ preservation through UW demonstrated a significantly better survival as compared with HTK (P < 0.001). Less AREs occurred in patients receiving tacrolimus‐sirolimus or tacrolimus‐MMF (P < 0.001). Patients receiving tacrolimus‐MMF showed less CAV than when treated with cyclosporine‐MMF (P < 0.005). There were more ventricular assist device implantations and more re‐HTx in era 6 (P < 0.0001) than when compared with other eras. Although the causes for improvement in survival over time are multifactorial, we believe that changes in immunosuppressive therapy have had a major impact on survival.

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“…Many of the heart studies have compared one preservation solution with another,26,29–33,35,39–44 and with or without additives, such as channel activators or blockers,1,11,45–49 exchange inhibitors,50–52 anesthetics,2,9,49 nitric oxide (NO) donors,53 perfluorocarbons54 or BDM 1,30,55. For example, Celsior solution preserved function better than ViaSpan in several studies,44,56 whereas others found that ViaSpan was better than Celsior 29,30. HTK was found to be more protective than ViaSpan in one study,43 whereas another found the reverse to be true 26.…”

Section: Discussionmentioning

confidence: 99%

Low-flow Perfusion of Guinea Pig Isolated Hearts With 26°C Air-saturated Lifor Solution for 20 Hours Preserves Function and Metabolism

Stowe

Camara

Heisner

et al. 2008

The Journal of Heart and Lung Transplantation

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Background-Donor human hearts cannot be preserved for >5 hours between explantation and recipient implantation. A better approach is needed to preserve transplantable hearts for longer periods, ideally at ambient conditions for transport. We tested whether Lifor solution could satisfactorily preserve guinea pig isolated hearts perfused at low flow with no added oxygen at room temperature for 20 hours.

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The UW solution has greater potential for longer preservation periods than the Celsior solution: comparative study for ventricular and coronary endothelial function after 24-h heart preservation

Abstract: The UW group showed better left ventricular function than the Celsior group, indicating that the UW solution has greater potential for long-term preservation than Celsior solution.

Cited by 24 publications

References 21 publications

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

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

Long-term outcomes after 1000 heart transplantations in six different eras of innovation in a single center

Low-flow Perfusion of Guinea Pig Isolated Hearts With 26°C Air-saturated Lifor Solution for 20 Hours Preserves Function and Metabolism

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