Continuous Perfusion Improves Preservation of Donor Rat Hearts: Importance of the Implantation Phase

Nickless, David; Rabinov, Marc; Richards, Stephen M.; Conyers, R. A. J.; Rosenfeldt, Franklin

doi:10.1016/s0003-4975(98)00172-6

Cited by 21 publications

(18 citation statements)

References 18 publications

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“…11 This functional superiority is in agreement with other large animal studies that used a variety of devices, solutions, temperatures, and storage intervals. [2][3][4][5][6][7][8][9] Of note, we observed a modest functional improvement despite a relatively brief storage interval, suggesting that benefits may be derived from this technique even within timeframes that are typically considered "safe" with conventional protection strategies.…”

Section: Discussionmentioning

confidence: 97%

“…1 Although perfusion devices have been found beneficial in experimental and clinical studies in kidney transplantation, efforts to test perfusion preservation in cardiac transplantation have been confined to animal studies, with various levels of success. [2][3][4][5][6][7][8][9] In theory, this preservation strategy should offer several advantages: it may allow ongoing aerobic metabolism for preservation of cellular energetics, maintenance of transmembrane ionic gradients, and support of reparative processes in ischemic myocardium. The flow of solution through the coronary bed may also wash out end products of anaerobic metabolism (such as lactate), thereby reducing intracellular acidosis.…”

mentioning

confidence: 99%

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Perfusion Preservation versus Static Preservation for Cardiac Transplantation: Effects on Myocardial Function and Metabolism

Rosenbaum

Peltz

DiMaio

et al. 2008

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Perfusion Preservation versus Static Preservation for Cardiac Transplantation: Effects on Myocardial Function and Metabolism

Rosenbaum

Peltz

DiMaio

et al. 2008

The Journal of Heart and Lung Transplantation

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“…1,2,24,25 Nevertheless, such a technique has never been significantly applied in clinical practice, since it would require an organ transport system with the possibility of organ perfusion and oxygenation. Cold (4°C) crystalloid cardioplegic solutions still represent the most important technique of graft preservation in almost all cardiac transplant institutions.…”

Section: Discussionmentioning

confidence: 99%

Determinants and prognostic value of ischemic necrosis in early biopsies following heart transplant

et al. 2000

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To evaluate the impact of early ischemic necrosis (IN) on the early and late outcome of heart transplantation, we reviewed our 11-year experience. Between January 1988 and June 1999, 207 heart transplants were performed in 205 patients (174 male and 31 female). Criteria for donor and recipient selection, and protocols for postoperative immunosuppression and rejection monitoring have remained unchanged over this period. Three different cardioplegic solutions were employed in graft preservation: St. Thomas Hospital solution in the earliest 31 cases (15%), University of Wisconsin solution in 96 cases (46.4%), and Celsior solution in the last 80 cases (38.6%). All patients who underwent at least one endomyocardial biopsy (176 patients) were divided into two groups according to the findings of IN within the early 3 postoperative months (group A, 49 patients with IN; group B, 127 patients without IN). The following variables were estimated in each group: donor and recipient age, ischemic time, type of cardioplegia, late mortality for cardiac causes, incidence of grade >2 rejection within the first 6 postoperative months, late incidence of grade >2 rejection, late incidence of NYHA class >II. No significant difference was found in any parameter between the two groups, except for the type of cardioplegic solution. A significantly higher incidence of ischemic necrosis in hearts preserved with St. Thomas solution was found (P < 0.001). Although pathology findings show that extracellular solutions carried a higher risk of early IN, no associated significant impairment in terms of late survival and event-free rate was observed in recipients with early IN.

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“…83,84 This further suggests that hepatocyte damage may contribute significantly to graft injury because in clinical liver transplantation, it is clear that prolonged rewarming ischemia during the implantation stage is a significant risk factor for graft dysfunction. 2,67,85,86 There is also evidence that rewarming ischemia is of critical importance in heart, 87 pancreas, 88 and kidney, 89 as well as lung, transplantation. 90 For example, the donor rat heart sustained injury during rewarming ischemia that could account for 50% of total ischemic injury.…”

Section: Rewarming Ischemia and Graft Dysfunctionmentioning

confidence: 99%

“…90 For example, the donor rat heart sustained injury during rewarming ischemia that could account for 50% of total ischemic injury. 87 Moreover, it appears that injury during rewarming ischemia of such organs as the liver, heart, pancreas, and kidney may be dependent on the preexisting energy state (e.g., tissue ATP content) of the organ. 91 As mentioned, one of our laboratories recently showed that hepatocyte functions can be severely compromised by rewarming ischemia.…”

Section: Rewarming Ischemia and Graft Dysfunctionmentioning

confidence: 99%

Role of hepatocytes and bile duct cells in preservation-reperfusion injury of liver grafts

Kukan

Haddad

2001

Liver Transplantation

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In liver transplantation, it is currently hypothesized that nonparenchymal cell damage and/or activation is the major cause of preservation-related graft injury. Because parenchymal cells (hepatocytes) appear morphologically well preserved even after extended cold preservation, their injury after warm reperfusion is ascribed to the consequences of nonparenchymal cell damage and/or activation. However, accumulating evidence over the past decade indicated that the current hypothesis cannot fully explain preservation-related liver graft injury. We review data obtained in animal and human liver transplantation and isolated perfused animal livers, as well as isolated cell models to highlight growing evidence of the importance of hepatocyte disturbances in the pathogenesis of normal and fatty graft injury. Particular attention is given to preservation time-dependent decreases in high-energy adenine nucleotide levels in liver cells, a circumstance that (1) sensitizes hepatocytes to various stimuli and insults, (2) correlates well with graft function after liver transplantation, and (3) may also underlie the preservation timedependent increase in endothelial cell damage. We also review damage to bile duct cells, which is increasingly being recognized as important in the long-lasting phase of reperfusion injury. The role of hydrophobic bile salts in that context is particularly assessed. Finally, a number of avenues aimed at preserving hepatocyte and bile duct cell integrity are discussed in the context of liver transplantation therapy as a complement to reducing nonparenchymal cell damage and/or activation. (Liver Transpl 2001;7: 381-400.)A lthough the use of University of Wisconsin (UW) solution has permitted an increase in mean preservation time, the incidence of graft dysfunction still persists, 1,2 contributing significantly to a more than 20% per year mortality rate for patients in liver transplantation centers in the United States. 3 In addition, when storage time exceeds 10 to 12 hours, such late posttransplantation complications as biliary strictures occur in more than 25% of liver transplant recipients. [4][5][6] To prevent or minimize graft dysfunction and posttransplantation complications, it is essential to fully understand the importance of individual liver cell types in graft injury induced by cold storage and reperfusion. Insight into the cellular and molecular basis of these injuries will lead to the development of better intervention strategies, which is very important because graft dysfunction results in increased morbidity and enhances mortality rates. 7,8 Moreover, up to 30% of patients with graft dysfunction need retransplantation as early as within the first 3 months after transplantation, 2,7,8 which increases the demand on an already short pool of donor organs.According to morphological studies, cold preservation leads to injuries of nonparenchymal cells, whereas liver parenchymal cells appear well preserved. It is currently hypothesized that sinusoidal endothelial cell impairment, 9-11 activatio...

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Continuous Perfusion Improves Preservation of Donor Rat Hearts: Importance of the Implantation Phase

Cited by 21 publications

References 18 publications

Perfusion Preservation versus Static Preservation for Cardiac Transplantation: Effects on Myocardial Function and Metabolism

Perfusion Preservation versus Static Preservation for Cardiac Transplantation: Effects on Myocardial Function and Metabolism

Determinants and prognostic value of ischemic necrosis in early biopsies following heart transplant

Role of hepatocytes and bile duct cells in preservation-reperfusion injury of liver grafts

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