Marginal donors: can older donor hearts tolerate prolonged cold ischemic storage?
OBJECTIVE
Both advanced donor age and prolonged ischemic time are significant risk factors for the 1-year mortality. However, its functional consequences have not been fully evaluated in the early-phase after transplantation; even early graft dysfunction is the main determinant of long-term outcome following transplantation. We evaluated in vivo left-ventricular (LV) cardiac and coronary vascular function of old-donor grafts after short and prolonged cold ischemic times in rats 1 h after heart transplantation.


METHODS
The hearts were excised from young donor (3-month-old) or old donor (18-month-old) rats, stored in cold preservation solution for either 1 or 8 h, and heterotopically transplanted.


RESULTS
After 1 h of ischemic period, in the old-donor group, LV pressure, maximum pressure development (dP/dt max), time constant of LV pressure decay (τ), LV end-diastolic pressure and coronary blood flow did not differ compared with young donors. However, endothelium-dependent vasodilatation to acetylcholine resulted in a significantly lower response of coronary blood flow in the old-donor group (33 ± 4 vs. 51 ± 15 %, p < 0.05). After 8 h preservation, two of the old-donor hearts showed no mechanical activity upon reperfusion. LV pressure (55 ± 6 vs. 72 ± 5 mmHg, p < 0.05), dP/dt max (899 ± 221 vs. 1530 ± 217 mmHg/s, p < 0.05), coronary blood flow and response to acetylcholine were significantly reduced and τ was increased in the old-donor group in comparison to young controls.


CONCLUSIONS
During the early-phase after transplantation, the ischemic tolerance of older-donor hearts is reduced after prolonged preservation time and the endothelium is more vulnerable to ischemia/reperfusion.
Laboratory of Cardiac Surgery, Department of Cardiac Surgery, University of Heidelberg, INF 326 (2. OG), 69120, Heidelberg, Germany, korkmaz@uni-heidelberg.de.
Sevil
S
Korkmaz
Susanne
S
Bährle-Szabó
Sivakkanan
S
Loganathan
Shiliang
S
Li
Matthias
M
Karck
Gábor
G
Szabó
D000818:Animals; D050377:Cold Ischemia / Q000009:adverse effects*; D003080:Cold Temperature / Q000009:adverse effects*; D003326:Coronary Circulation / Q000502:physiology; D006321:Heart / Q000502:physiology*; D016027:Heart Transplantation / Q000009:adverse effects*; D008297:Male; D019188:Organ Preservation Solutions; D051381:Rats; D011917:Rats, Inbred Lew; D014664:Vasodilation / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology
D019188:Organ Preservation Solutions