The role of leukocyte depleting filters in heart transplantation: early outcomes in prospective, randomized clinical trial.
OBJECTIVE
Leukocyte-mediated reperfusion injury to cardiac allograft in the perioperative period is most likely associated with the early and late mortality after heart transplantation (Htx). Our aim is to determine the efficacy and safety of using leukocyte-depleting filters in a cardiopulmonary bypass (CPB) and secondary blood cardioplegia (SBC) circuit in Htx.


METHODS
A prospective, randomized trial was performed in 40 patients undergoing orthotopic Htx. These patients were divided into two groups, to be treated with either leukocyte-depleted (LD) reperfusion (n=20) in the LD group, or whole blood reperfusion (n=20) in the Control group. The SBC was used in both groups.


RESULTS
Intraoperatively, the LD group presented the reduced markers of reperfusion injury. The course of the creatine kinase MB (CK-MB) releases was significantly lower in the LD group (p<0.05). The LD hearts showed better spontaneous rhythm resumption (60% vs 10%; p<0.001), and lower need for isoprenaline (0.02+/-0.01 microg/(kg min) vs 0.03+/-0.02 microg/(kg min); p<0.05) and epicardial pacing (25% vs 60%; p<0.05) for weaning off CPB. Postoperatively, lower and shorter need for inotropic support (48+/-46, median=35 h vs 131+/-68, median=109 h; p<0.001), shorter temporary epicardial pacing (6+/-14, median=0 h vs 25+/-52, median=1 h; p<0.01), and lower 24-h chest drainage (551+/-274, median=500 ml vs 973+/-836, median=665 ml; p<0.05) in the LD group contributed to the shorter mechanical ventilation time (8+/-3, median=7.5 h vs 14+/-12, median=8.5 h; p<0.05) and the shorter stay at an intensive care unit (ICU) (70+/-24 h vs 116+/-73 h; p<0.05). The 30-day mortality was zero in both groups.


CONCLUSIONS
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.
Dvorak
Lubos
L
Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. lubos.dovak@seznam.cz
Pirk
Jan
J
Cerny
Stepan
S
Kovar
Jan
J
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002304:Cardiac Pacing, Artificial; D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D052279:Creatine Kinase, MB Form / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005374:Filtration / Q000295:instrumentation; D006324:Heart Arrest, Induced; D006331:Heart Diseases / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007545:Isoproterenol / Q000627:therapeutic use; D047589:Leukocyte Reduction Procedures / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D011446:Prospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D015415:Biomarkers; D052279:Creatine Kinase, MB Form; D007545:Isoproterenol