Hypothermic preservation of donor grafts is imperative to ameliorate ischemia related cellular damage prior to organ transplantation. Numerous solutions are in existence with widespread variability among transplant centers as to a consensus regarding the optimal preservation solution. Here, we present a concise review of pertinent preservation studies involving cardiac and pulmonary allografts in an attempt to minimize the variability among institutions and potentially improve graft and patient survival. A biochemical comparison of common preservation solutions was undertaken with an emphasis on Euro Collins (EC), University of Wisconsin (UW), histidine-tryptophan-ketoglutarate (HTK), Celsior (CEL), Perfadex (PER), Papworth, and Plegisol. An appraisal of the literature ensued containing the aforementioned preservation solutions in the setting of cardiac and pulmonary transplantation. Available evidence supports UW solution as the preservation solution of choice for cardiac transplants with encouraging outcomes relative to notable contenders such as CEL. Despite its success in the setting of cardiac transplantation, its use in pulmonarytransplantation remains suboptimal and improved outcomes may be seen with PER. Together, we suggest, based on the literature that the use of UW solution and PER for cardiac and pulmonary transplants, respectively may improve transplant outcomes such as graft and patient survival.
Infusión de manitol en los 15 minutos de pinzamiento mejora la conservación renal de donante vivo.
Mannitol infusion within 15 min of cross-clamp improves living donor kidney preservation.
Andrews PM, Cooper M, Verbesey J, Ghasemian S, Rogalsky D, Moody P, Chen A, Alexandrov P, Wang HW, Chen Y.
Transplantation. 2014 Oct 27;98(8):893-7. doi: 10.1097/TP.0000000000000154.
BACKGROUND: Optical coherence tomography (OCT) revealed that cells lining proximal convoluted tubules of living donor kidneys (LDKs) procured by laparoscopic procedures were very swollen in response to the brief period of ischemia experienced between the time of arterial vessel clamping and flushing the excised kidney with cold preservation solution. Damage to the tubules as a result of this cell swelling resulted in varying degrees of acute tubular necrosis (ATN) that slowed the recovery of the donor kidneys during the first 2 weeks after their transplantation. METHODS: To prevent this cell damage during LDK procurement, we changed the protocol for intravenous administration of mannitol (i.e., 12.5 or 25 g) to the donor. Specifically, we reduced the time of mannitol administration from 30 to 15 min or less before clamping the renal artery. RESULT: OCT revealed that this change in the timing of mannitol administration protected the human donor proximal tubules from normothermic-induced cell swelling. An evaluation of posttransplant recovery of renal function showed that patients treated with this modified protocol returned to normal renal function significantly faster than those treated with mannitol 30 min or more before clamping the renal artery. CONCLUSION: Because slow graft recovery in the first weeks after transplantation represents a risk factor for long-term graft function and survival, we believe that this change in pretreatment protocol will improve renal transplants in patients receiving LDK.
Custodiol para protección y preservación miocárdica. Revisión sistemática
Custodiol for myocardial protection and preservation: a systematic review. Edelman JJ, Seco M, Dunne B, Matzelle SJ, Murphy M, Joshi P, Yan TD, Wilson MK, Bannon PG, Vallely MP, Passage J. Ann Cardiothorac Surg. 2013 Nov;2(6):717-28. doi: 10.3978/j.issn.2225-319X.2013.11.10. Abstract INTRODUCTION: Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant. METHODS: Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant. RESULTS: Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant. CONCLUSIONS: Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required. KEYWORDS: Custodiol solution; cardiac transplantation; heart arrest; histidine-tryptophan-ketoglutarate solution; induced PDF