Does University of Wisconsin solution harm the transplanted heart?
BACKGROUND
University of Wisconsin solution (UW) has been shown to be an effective preservative for the cardiac allograft. Recently, the high potassium content of UW has been implicated in causing coronary endothelial damage, allegedly contributing to development of cardiac allograft vasculopathy (CAV) and eventually to poorer survival.


METHODS
We examined our experience using UW for preservation of cardiac allografts between 1990 and 1994 (n = 94), and compared these to hearts preserved with the lower potassium-containing Stanford solution used at our center between 1986 and 1990 (n = 65). Indices of graft function, ischemic injury, CAV incidence, CAV severity, and survival were evaluated.


RESULTS
The 2 groups were similar in age, gender, diagnosis, donor inotropic support, donor-recipient weight ratio, incidence of acute graft failure, and cytomegalovirus seroconversion. UW-preserved hearts came from older donors (30.5 vs 24.1 years, p < .001), and were transplanted into more status 1 recipients (56% vs 22%, p < .001), consistent with current trends. Mean ischemic time of UW-preserved hearts was significantly longer (184 vs 155 minutes, p < .005) although time required to wean from bypass was less (45.5 vs 73.8 minutes, p < .001) and there was a trend towards less inotropic requirement. CPK-MB release was less with UW preservation (63 vs 87 microg/ dL, p = .001). Three years after transplantation, both groups were similar in the incidence of CAV (UW, 27.3%; STNF, 37.5%; p = 0.27), and also the severity of CAV (p = 0.78). Deaths attributed to CAV were equal in each group (UW, 11.4% vs STNF, 10.7%; p = 0.79). Kaplan-Meier survival analysis revealed equivalent survival curves (p = 0.26).


CONCLUSIONS
We conclude that UW is a safe and effective myocardial preservative, allowing longer ischemic times with equivalent graft function. Our data suggest that when UW is used for cardiac allograft preservation, both CAV and survival are comparable to the experience with other preservatives containing lower concentrations of potassium.
Division of Cardiothoracic Surgery, University of Wisconsin Hospitals and Clinics, Madison, USA.
J C
JC
Stringham
R B
RB
Love
D
D
Welter
C C
CC
Canver
R M
RM
Mentzer
D000241:Adenosine / Q000009:adverse effects; D000493:Allopurinol / Q000009:adverse effects; D002314:Cardioplegic Solutions / Q000009:adverse effects*; D003327:Coronary Disease / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D003331:Coronary Vessels / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D005978:Glutathione / Q000009:adverse effects; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D007328:Insulin / Q000009:adverse effects; D009926:Organ Preservation; D019188:Organ Preservation Solutions; D011183:Postoperative Complications / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D011887:Raffinose / Q000009:adverse effects; D012189:Retrospective Studies; D014184:Transplantation, Homologous
D002314:Cardioplegic Solutions; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose