Clinical experience supplementing celsior preservation solution with pro-survival kinase agents glyceryl trinitrate and erythropoietin demonstrates excellent myocardial recovery post cardiac transplantation

Gayathri Kumarasinghe^1,2, Arjun Iyer^1,2, Andrew Jabbour^1,2, Peter Macdonald^1,2, Phillip Spratt¹, Kumud Dhital^1,2, Paul Jansz¹, Emily Granger¹, Alasdair Watson^1,2, Mark Hicks², Ling Gao², Anne Keogh^1,2, Eugene Kotlyar¹, Christopher Hayward^1,2, Aoife Doyle², Padmashree Rao²

¹Heart and Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia, ²Cardiac Physiology and Transplant Laboratory, Victor Chang Cardiac Research Institute, Sydney, Australia

 Aim: Primary graft failure (PGF) is the leading cause of early morbidity and mortality in cardiac transplantation[1]. We have shown in animal models that myocardial recovery is significantly improved by supplementing preservation solutions with pro-survival kinase agents that reduce ischaemia-reperfusion injury[2,3]. We translated these findings into clinic practice by supplementing Celsior solution with two agents glyceryl trinitrate (G) and erythropoietin (E) and report our findings.

Methods: Cardiac transplants performed in our institution since June 2010 used Celsior+G+E for cardioplegia and hypothermic storage. Donor and recipient baseline data, ischaemic time and post-transplant outcomes were retrospectively compared with historical controls where hearts were procured using Celsior alone.

Results: Celsior+G+E was used for 51 transplants (June 2010-February 2013), and Celsior alone was used for 104 transplants (March 2005-June 2010). There was increased use of left ventricular assist devices (LVADs) and a trend towards higher numbers of marginal donors in the Celsior+G+E group. There was a trend towards reduced PGF (lower use of mechanical circulatory assist devices) and improved survival in this group.

Conclusion: Despite increasing use of marginal donors and LVADs, supplementing Celsior with glyceryl trinitrate and erythropoietin allows excellent recovery of donor hearts.

Figure 1