Background: Limited data exist that compare the predominant cardiac preservation solutions (CPSs). Materials and methods: The United Network for Organ Sharing database was retrospectively reviewed from January 1, 2004 to March 31, 2018, for donor hearts. Of 34,614 potential donors, 21,908 remained after applying the exclusion criteria. The CPS analyzed included saline, the University of Wisconsin (UW), cardioplegia, Celsior, and Custodiol. The primary endpoints were recipient survival and posttransplant rejection. Logistic and Cox models were used to quantify survival endpoints. Results: Saline was used as the CPS in 2549 patients (12%), UW in 10,549 (48%), cardioplegia in 1307 (6%), Celsior in 5081 (23%), and Custodiol in 2422 (11%). Donor age ranged from 15 to 68 y (mean ¼ 32.0 y, median ¼ 30.0 y), and 71% were male. Adjusted survival probabilities of recipients whose donor hearts were procured with saline was 96% 30 d, 90% 1 y, UW: 97% 30 d, 92% 1 y, cardioplegia: 95% 30 d, 87% 1 y, Celsior: 96% 30 d, 90% 1 y, and Custodiol: 97% 30 d, 92% 1 y. When these comparisons were adjusted for donor age, sex, ethnicity, ischemic time, recipient age, sex, ethnicity, creatinine, ventricular assist device (VAD), length of stay, region and days on waiting list, cardioplegia solution was demonstrated to have a higher risk of death (30 d, 1 y, overall) and posttransplant rejection versus UW (odds ratio 1.70, P ¼ 0.001; odds ratio 1.63, P < 0.001; hazard ratio 1.22, P < 0.001; hazard ratio 1.21, P < 0.001, respectively). Conclusions: Cardioplegia solutions for cardiac preservation are associated with a higher mortality in heart transplant recipients.
Background-Post-injury hypercoagulability occurs in >25% of injured patients, increasing risk of thromboembolic complications despite chemoprophylaxis. However, few clinically relevant animal models of posttraumatic hypercoagulability exist. We aimed to evaluate a rodent model of bilateral hindlimb injury as a preclinical model of post-injury hypercoagulability.Methods-Forty Wistar rats were anesthetized with isoflurane: twenty underwent bilateral hindlimb fibula fracture, soft tissue and muscular crush injury, and bone homogenate injection intended to mimic the physiological severity of bilateral femur fracture. Twenty sham rats underwent anesthesia only. Terminal citrated blood samples drawn at 0, 6, 12, and 24h (n=5 per timed group) for analysis by native thromboelastography (TEG) in the presence and absence of taurocholic acid (TUCA) to augment fibrinolysis. Plasminogen activator inhibitor 1 (PAI-1) and alpha-2 antiplasmin (A2AP) levels in plasma were assessed via ELISA.Results-Injured rats became hypercoagulable relative to baseline by 6h based on TEG MA and G (p<0.005); sham rats became hypercoagulable to a lesser degree by 24h (p<0.005). Compared to sham animals, injured rats were hypercoagulable by MA and G within 6h of injury, remained hypercoagulable by MA and G through at least 24h (all p<0.01), and showed impaired fibrinolysis by TUCA LY30 at 12h (p=0.019) and native LY30 at 24h (p=0.045).
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