Effects of Celsior and University of Wisconsin preservation solutions on hemodynamics and endothelial function after cardiac transplantation in humans: a single-center, prospective, randomized trial

Abstract

Optimal preservation of the myocardium remains a major concern in clinical and experimental heart transplantation. The present study compared the efficacy of University of Wisconsin (UW) and Celsior preservation solution with respect to myocardial performance, epicardial and microvascular endothelial vasomotor function and myocardial expression of endothelin and nitric oxide synthases in humans. Forty-one cardiac transplant recipients received either UW (n = 20) or Celsior (n = 21) preserved hearts. Catecholamine and vasodilator requirements were assessed within the first 5 postoperative days. Left ventricular performance and endothelial function was assessed 1 month after transplantation. Endothelin and nitric oxide synthase gene expression were detected in myocardial biopsy samples. Celsior preserved hearts required significantly more catecholamines and vasodilators within the first 5 postoperative days. Myocardial performance and endothelial function were comparable 1 month after transplantation. Total ischemic time correlated with impaired endothelial function in the Celsior but not in the UW group. Endothelin and inducible nitric oxide synthase gene expression were significantly higher in the Celsior group. The results of the study show that both solutions provide myocardial protection with regard to left ventricular performance and endothelial function 1 month after cardiac transplantation. The necessity for higher vasodilator and catecholamine therapy in Celsior preserved hearts suggests post-ischemic myocardial stunning within the first 5 postoperative days. The positive correlation between impaired endothelial function and total ischemic time in the Celsior group requires longitudinal investigation in particular with regard to the development of allograft vasculopathy.

Organ storage with University of Wisconsin solution is associated with improved outcomes after orthotopic heart transplantation

“…Previous studies have suggested that allografts preserved with CS have an increased post-transplant need for inotropic support. 13,14 Weaning such vasoactive support can take time and may have contributed to the longer LOS observed in this study.…”

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

“…In this study, the Celsior group showed less left ventricular function compared with the UW group. Some investigators reported that Celsiorpreserved hearts required more inotropic support in the early phase after transplantation [14], and these investigators assumed a reversible dysfunction as the underlying phenomenon.…”

“…Some investigators have shown that the Celsior solution has the advantages of being able to prevent free radical injury [10], coronary endothelial damage [11,12], and depletion of adenine nucleotides [13]. However, other investigators have reported the necessity of a higher dose of catecholamines postoperatively [14] and higher frequency of necessary defibrillations [15,16].…”

Impact of Donor Serum Sodium Levels on Outcome After Heart Transplantation

“…12,13 UW was the standard preservation solution for the investigation period, which might have contributed to the finding that increased donor serum sodium levels have no significant impact on the outcome variables assessed.…”