The role of leukocyte depleting filters in heart transplantation: early outcomes in prospective, randomized clinical trial

L, Dvorák; Pirk, Jan; Černý, Štěpán; Kovář, J.

doi:10.1016/j.ejcts.2006.07.022

Cited by 11 publications

(2 citation statements)

References 19 publications

(15 reference statements)

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“…There are examples in the literature of centers (UCLA, Albert‐Ludwigs‐University Freiburg) that have implemented different controlled reperfusion strategies in a standardized manner before aortic cross‐clamp release that are of interest to further investigate 22‐24 . In the report from the ISHLT consensus on PGF, Johns Hopkins University states that they drop FI O2 before the release of cross‐clamp which is not further explained but interesting 6 .…”

Section: Discussionmentioning

confidence: 99%

The influence of ischemia and reperfusion time on outcome in heart transplantation

Jernryd

Metzsch

Andersson

et al. 2020

Clinical Transplantation

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractIschemia/reperfusion may lead to graft dysfunction in heart transplantation (HT).The purpose of this study was to evaluate the influence of ischemic and reperfusion time on acute cellular rejection (ACR) within the first-year post-HT and on long-term outcomes. Data were collected from 331 patients (mean age 49 ± 12 y, 28% females) who underwent HT 1988-2016. Endomyocardial biopsies obtained within the first year after HT were graded according to the 2004-ISHLT-WF. We classified the patients by ischemic time 4 hours, and of these, 31 (55%) patients had reperfusion with CPB ≥90 minutes. Ischemia >4 hours had an increased risk of ACR ≥ 2R during the first year (adjusted OR = 3.1, P = .016); however, an extended reperfusion ≥90 minutes reduced the risk (adjusted OR = 0.25, P = .024). The conditional probability of surviving 10 years post-transplant, given that the patients already survived first year, was inferior for recipients with ischemia ≥ 4 hours and reperfusion <90 minutes, 59%, compared with the other groups 83%, P = .016. Prolonged reperfusion appears to reduce the risk for ACR ≥ 2R and improve long-term survival. K E Y W O R D Sacute cellular rejection, heart transplantation, ischemic time, reperfusion

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Section: Discussionmentioning

confidence: 99%

The influence of ischemia and reperfusion time on outcome in heart transplantation

Jernryd

Metzsch

Andersson

et al. 2020

Clinical Transplantation

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“…Continuous leukocyte filtration with arterial line filters incorporated into the circuit has shown mixed results in terms of attenuation of inflammation, oxidative stress, and organ dysfunction during and after CPB. It has also been reported that placing the leukocyte filter in venous line, while still efficiently filtering the leukocytes, may cause lower leukocyte damage and thus, better attenuate inflammation (160)(161)(162)(163)(164).…”

Section: Leukocyte Filtrationmentioning

confidence: 99%

Inflammation and Oxidative Stress in the Context of Extracorporeal Cardiac and Pulmonary Support

2022

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Extracorporeal circulation (ECC) systems, including cardiopulmonary bypass, and extracorporeal membrane oxygenation have been an irreplaceable part of the cardiothoracic surgeries, and treatment of critically ill patients with respiratory and/or cardiac failure for more than half a century. During the recent decades, the concept of extracorporeal circulation has been extended to isolated machine perfusion of the donor organ including thoracic organs (ex-situ organ perfusion, ESOP) as a method for dynamic, semi-physiologic preservation, and potential improvement of the donor organs. The extracorporeal life support systems (ECLS) have been lifesaving and facilitating complex cardiothoracic surgeries, and the ESOP technology has the potential to increase the number of the transplantable donor organs, and to improve the outcomes of transplantation. However, these artificial circulation systems in general have been associated with activation of the inflammatory and oxidative stress responses in patients and/or in the exposed tissues and organs. The activation of these responses can negatively affect patient outcomes in ECLS, and may as well jeopardize the reliability of the organ viability assessment, and the outcomes of thoracic organ preservation and transplantation in ESOP. Both ECLS and ESOP consist of artificial circuit materials and components, which play a key role in the induction of these responses. However, while ECLS can lead to systemic inflammatory and oxidative stress responses negatively affecting various organs/systems of the body, in ESOP, the absence of the organs that play an important role in oxidant scavenging/antioxidative replenishment of the body, such as liver, may make the perfused organ more susceptible to inflammation and oxidative stress during extracorporeal circulation. In the present manuscript, we will review the activation of the inflammatory and oxidative stress responses during ECLP and ESOP, mechanisms involved, clinical implications, and the interventions for attenuating these responses in ECC.

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Leukocyte depletion for safe blood transfusion

Singh

Kumar

2009

Biotechnology Journal

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Leukocytes have ability to distinguish between self cells (body own cells) and foreign (allogenic) cells on the basis of human leukocyte antigen (HLA) proteins that are present on the cell membrane and are effectively unique to a person. During allogenic blood transfusion a person receives large number of allogenic donor leukocytes and these are recognized as foreign cells by the recipient immune system which leads to several adverse reactions. To avoid such leukocyte-mediated adverse reactions leukodepleted blood transfusion is required. Leukocytes can be separated on the basis of size, dielectric properties, by affinity separation, freeze-thawing and centrifugation but all these methods are time consuming and costly. Filtration is another method for leukocyte depletion that is comparatively less expensive and more efficient as it gives more than 90% leukodepletion of blood along with minimal cell loss. However, present filtration procedures also have some limitations as they work efficiently with blood components but not with whole blood and show non-specific adhesion of large number of platelets and red blood cells along with leukocytes. All the currently available filters are costly, which has been a major reason for their limited application. Therefore, demand for a more efficient and cost-effective filter is high in medical community and scientists are attenpting to improve the efficiency of currently available filters. The present review gives an overview of the significance of leukodepleted blood transfusion and focuses on different methods for leukocyte depletion and challenges involved in all these technologies.

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The role of leukocyte depleting filters in heart transplantation: early outcomes in prospective, randomized clinical trial

Abstract: The use of leukocyte depleting filters in heart transplantation is an effective, easy and safe method of myocardial protection, reducing significant myocardial reperfusion injury and improving posttransplant graft functional recovery.

Cited by 11 publications

References 19 publications

The influence of ischemia and reperfusion time on outcome in heart transplantation

The influence of ischemia and reperfusion time on outcome in heart transplantation

Inflammation and Oxidative Stress in the Context of Extracorporeal Cardiac and Pulmonary Support

Leukocyte depletion for safe blood transfusion

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