2013 - ISODP 2013 Congress


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Oral Presentation 15 on Organ Preservation

31.4 - A donor whole blood-based perfusate provides superior preservation of myocardial function during ex vivo heart perfusion

Presenter: Christopher W., White, Winnipeg, Canada
Authors: Christopher W. White, Paul Mundt, Yun Li, Devin Hasanally, Bo Xiang, Rakesh C. Arora, Trevor W. Lee, Amir Ravandi, Ganghong Tian, Larry Hryshko, Darren H. Freed

A donor whole blood-based perfusate provides superior preservation of myocardial function during ex vivo heart perfusion

Christopher W. White1,2, Paul Mundt1, Yun Li2, Devin Hasanally2, Bo Xiang2, Rakesh C. Arora1,2, Trevor W. Lee3, Amir Ravandi2, Ganghong Tian4, Larry Hryshko2, Darren H. Freed1,2

1Cardiac Surgery, University of Manitoba, Winnipeg, MB, Canada, 2Institute of Cardiovascular Sciences, University of Manitoba, Winnipeg, MB, Canada, 3Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada, 4National Research Council Institute for Biodiagnostics, Winnipeg, MB, Canada

Background: Discarded hearts from brain-dead and DCD donors represent unutilized organs for transplantation; however, demonstration of adequate function prior to transplant is necessary. Ex vivo heart perfusion (EVHP) facilitates such functional assessment. We sought to determine what type of oxygen carrier provides superior preservation of myocardial function during EVHP.

Methods: 27 pig hearts were procured and underwent EVHP for 6 hours. Hearts were allocated to 4 groups according to the composition of the perfusate solution. Donor red blood cell concentrate (RBC, N=6), donor whole blood (RBC+Plasma, N=6), an acellular hemoglobin based oxygen carrier (HBOC, N=8), or HBOC plus donor plasma (HBOC+Plasma, N=7) were added to STEEN solution to achieve a hemoglobin concentration of 40 g/L. Myocardial function was assessed in working mode using pressure-volume loop analysis. Oxidative stress was assessed through quantification of oxidized phosphatidylcholine (OxPC) compounds using mass spectrometry. Myocardial energetics was assessed using magnetic resonance spectroscopy.

Results: A hemoglobin concentration of 40 g/L preserved myocardial energetics. Systolic function was comparable between treatment groups. Diastolic function was assessed using the end-diastolic pressure-volume relationship (EDPVR) and was superior in RBC+Plasma hearts at 1, 3, and 5-hours of EVHP (Figure 1). Donor plasma reduced the generation of OxPC compounds (Figure 2) and the development of myocardial edema in HBOC perfused hearts (HBOC+Plasma 9.8±1.7 vs. HBOC 16.3±1.9 grams/hr, p=0.03) but not in RBC perfused hearts (RBC+Plasma 6.6±0.9 vs. RBC 6.6±1.2 grams/hr, p=0.98).

Conclusion: During EVHP a hemoglobin concentration of 40 g/L preserves myocardial energetics.  Donor plasma minimizes oxidative stress and the development of myocardial edema, and a donor whole blood-based solution (RBC+Plasma) provides superior preservation of diastolic function.

Figure 1

Figure 2


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