Clinical heart transplantation with extended preservation time (>5 hours): experience with University of Wisconsin solution.
BACKGROUND
Use of University of Wisconsin solution has been suggested for extended organ preservation >4 hours in experimental cardiac transplantation, but few data have been reported from clinical use. This study investigated the impact of preservation with UW solution after prolonged ischemic times on myocardial damage and outcomes after heart transplantation.


METHODS
Between 1994 and 2006, 34 orthotopic heart transplantations were performed at our institution with cold ischemic times of >or=300 minutes (mean, 325.1 +/- 21.3). Donor organs were perfused with and stored in 1000 mL of University of Wisconsin solution. No significant differences were observed with regard to age, gender, diagnosis, donor inotropic support, and donor-recipient weight ratio when compared with recipients undergoing an ischemic time <300 minutes.


RESULTS
After a mean follow-up of 47.6 months (range, 1 day to 147.1 months), Kaplan-Meier survival analysis revealed survivals of 91.0% at 3 months, and 82.9% for the entire observation period. The time required to wean from bypass (mean, 78.1 minutes) was equal when compared with that of recipients experiencing grafts undergoing an ischemic time of <300 minutes, but there was a significantly greater average need for inotropic support over the first 48 posttransplant hours. Neither hospital stay in the ICU (mean, 13.0 days; range, 1-55 days) nor the incidence of acute graft failure or survival was different.


CONCLUSIONS
We conclude that heart preservation with UW limited ischemic damage from prolonged storage and improved myocardial function in the early posttransplant period, thus allowing transplantation of organs with ischemic times >300 minutes.
Kur
F
F
Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany.
Beiras-Fernandez
A
A
Meiser
B
B
Uberfuhr
P
P
Reichart
B
B
D000241:Adenosine / Q000627:therapeutic use; D000328:Adult; D000493:Allopurinol / Q000627:therapeutic use; D002423:Cause of Death; D005260:Female; D005978:Glutathione / Q000627:therapeutic use; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000706:statistics & numerical data; D019188:Organ Preservation Solutions / Q000627:therapeutic use; D011379:Prognosis; D011887:Raffinose / Q000627:therapeutic use; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors
D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose