Steroids Limit Myocardial Edema During Ex Vivo Perfusion of Hearts Donated After Circulatory Death

Abstract

The addition of methylprednisolone to the perfusion solution minimizes the generation of proinflammatory cytokines and development of myocardial edema during normothermic ex vivo perfusion of hearts donated after circulatory arrest.

Myocardial Functional Decline During Prolonged Ex Situ Heart Perfusion

“…The myocardial functional decline during ESHP has been observed in previous studies [5]; however, the severity of myocyte necrosis and apoptosis that occurs in this context has not been previously characterized. This study found the proportion of TUNEL-positive cells was significantly higher in the myocardium after 12 hours of ESHP compared with in vivo samples; however, the overall frequency of apoptotic cells was low (<1%) and out of proportion to the observed decline in myocardial function over time.…”

“…MYOCARDIAL EDEMA. The heart weight gain (edema formation) during the 12-hour ESHP was calculated as a percentage of the initial heart weight, as described previously [5].…”

“…Experimental models of ESHP have demonstrated that myocardial function declines in a time-dependent fashion during normothermic perfusion [5] and that the mechanisms responsible for this phenomenon have not been elucidated. Perfusate markers of myocyte injury increase during ESHP; however, the degree of myocardial dysfunction appears to be out of proportion to the severity of myocardial injury observed histologically [6].…”

Transplantation of Hearts Donated after Circulatory Death

“…The OCS prime solution is supplemented with methylprednisolone in order to minimize myocardial edema. Donor heart exposure to extracorporeal circulation during ESHP has been shown to elicit an inflammatory response, with a 60-fold increase in pro-inflammatory cytokines observed over a 5-h preservation interval ( 145 ). Methylprednisolone may limit this inflammatory response and minimize the development of myocardial edema ( 145 ).…”

“…Donor heart exposure to extracorporeal circulation during ESHP has been shown to elicit an inflammatory response, with a 60-fold increase in pro-inflammatory cytokines observed over a 5-h preservation interval ( 145 ). Methylprednisolone may limit this inflammatory response and minimize the development of myocardial edema ( 145 ). Oshima et al have also demonstrated that the suppression pro-inflammatory cytokines during ESHP improves posttransplant myocardial function ( 146 ).…”