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Ann Thorac Surg 1999;68:1634-1635
© 1999 The Society of Thoracic Surgeons
a Division of Transplantation, Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI 53792, USA
e-mail: southard{at}surgadmin.surgery.wisc.edu
Invited commentary
This is a very well done and fair presentation of how temperature affects the efficacy of University of Wisconsin (UW) organ preservation solution. This solution was designed for hypothermic (0°C to 4°C) storage of organs. As shown by Ou and colleagues, UW solution at higher temperatures is not favorable for storage of the heart. Some components of the solution (the high concentration of potassium, in particular) are not well tolerated by cells at warm temperatures. Also, the lack of calcium in UW solution may render it less efficacious at temperatures greater than 10°C. Ou and associates demonstrate this clearly in their rat heart model of cardioplegia and reperfusion.
This study by Ou and coworkers not only shows the detrimental aspects of UW solution but also goes further than most other studies to point out the major advantages of this solution when used properly, at 4°C, in the heart. In addition, on the basis of their results, Ou and coauthors conclude that the benefits of UW solution for heart storage can still be obtained if the organ exposed to this solution is not allowed to warm. Thus, UW solution should be replaced by a high sodium solution before the initiation of implantation. This pretransplantation flush is advantageous because it removes the UW solution with its high concentrations of potassium and adenosine. Further, the flushing is an important transplantation strategy because it removes potentially harmful toxic agents that accumulate during the period of cold storage. These toxicants include proteases, cytokines, and other metabolites released from injured and metabolically active cells and can cause both damage to the organ when it is warmed and systemic injury if they are released into the circulation.
This carefully done study also shows that a solution containing a high concentration of potassium is probably not injurious to the vascular system of the heart when used properly, ie, at 4°C. In fact, the study discusses evidence that solutions containing a high concentration of potassium may be more beneficial than those with a high sodium concentration. A major contribution of this study is the demonstration of the importance of procedural or technical manipulations in cardiac transplantation (ie, vascular flushing before transplantation). In fact, this and other technical aspects of the operation may be more important than the preservation solution used when storage times are limited (10 hours or less).
Much is written about preservation solutions, and various groups try to demonstrate the superiority of their solution over others. In reality, however, for short preservation periods, all solutions are probably equal in efficacy. As this study shows, how the heart is treated may be more important than the actual preservation solution used. Careful attention to the quality of the donor, the experience of the harvest and transplant teams, the condition of the recipient, and management after heart transplantation may be more important to the outcome than the type of preservative used. In the transplant center at the University of Wisconsin, the UW solution continues to provide excellent intraabdominal and intrathoracic organ preservation. Studies such as this one provide the field of transplantation with the needed technical considerations required to optimize current organ-preservation technology.
Related Article
Ann. Thorac. Surg. 1999 68: 1628-1634.
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