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

BACKGROUND: Ex vivo heart perfusion (EVHP) provides the opportunity to resuscitate unused;donor ex vivo heart organs and facilitates assessments of myocardial function that are required to demonstrate organ perfusion; viability before transplantation. We sought to evaluate the effect of different oxygen carriers on the myocardial function; preservation of myocardial function during EVHP. oxygen delivery; METHODS: Twenty-seven pig hearts were perfused ex vivo in a normothermic beating state for 6 hours myocardial energy and transitioned into working mode for assessments after 1 (T1), 3 (T3), and 5 (T5) hours. Hearts were metabolism; allocated to 4 groups according to the perfusate composition. Red blood cell concentrate (RBC, n = 6), hemoglobin-based whole blood (RBC+Plasma, n = 6), an acellular hemoglobin-based oxygen carrier (HBOC, n = 8), or oxygen carrier; HBOC plus plasma (HBOC+Plasma, n = 7) were added to STEEN Solution (XVIVO perfusion, HBOC; Goteborg, Sweden) to achieve a perfusate hemoglobin concentration of 40 g/liter. ex vivo perfusate RESULTS: The perfusate composition affected the preservation of systolic (T5 dP/dt(max) : RBC+Plasma = 903 +/- 99, RBC = 771 +/- 77, HBOC+Plasma = 691 +/- 82, HBOC = 563 +/- 52 mm Hg/sec; p = 0.047) and diastolic (T5 dP/dt(min): RBC+Plasma = 574 +/- 48, RBC = 492 +/- 63, HBOC+Plasma = -326 +/- 32, HBOC = -268 +/- 22 mm Hg/sec; p < 0.001) function, and the development of myocardial edema (weight gain: RBC+Plasma = 6.6 +/- 0.9, RBC = 6.6 +/- 1.2, HBOC+Plasma = 9.8 +/- 1.7, HBOC = 16.3 +/- .9 g/hour; p < 0.001) during EVHP. RBC+Plasma hearts exhibited less histologic evidence of myocyte damage (injury score: RBC+Plasma = 0.0 +/- 0.0, RBC = 0.8 +/- 0.3, HBOC+Plasma = 2.6 +/- 0.2, HBOC = 1.75 +/- 0.4; p < 0.001) and less troponin-I release (troponin-I fold-change T1-T5: RBC+Plasma = 7.0 +/- 1.7, RBC = 13.1 +/- 1.6, HBOC+Plasma = 20.5 +/- 1.1, HBOC = 16.7 +/- 5.8; p < 0.001). Oxidative stress was minimized by the addition of plasma to RBC and HBOC hearts (oxidized phosphatidylcholine compound fold-change T1 T5: RBC+Plasma = 1.83 +/- 0.20 vs RBC = 2.31 +/- 0.20, p < 0.001; HBOC+Plasma = 1.23 +/- 0.17 vs HBOC = 2.80 +/- 0.28, p < 0.001). CONCLUSIONS: A whole blood based perfusate (RBC-I-Plasma) minimizes injury and provides superior preservation of myocardial function during EVHP. The beneficial effect of plasma on the preservation of myocardial function requires further investigation. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.