Peltz Matthias, He Tian-Teng, Adams Glenn A, Koshy Seena, Burgess Shawn C, Chao Robert Y, Meyer Dan M, Jessen Michael E
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, 75390-8879, USA.
Surgery. 2005 Oct;138(4):795-805. doi: 10.1016/j.surg.2005.06.040.
Machine perfusion preservation improves reperfusion function of many solid organs, compared with conventional storage, but has received limited clinical attention in preserving hearts for transplantation. We evaluated representative extracellular (Celsior) and intracellular (University of Wisconsion) storage solutions using static and perfusion protective strategies over a clinically relevant preservation period.
Rat hearts were preserved for 200 minutes by either static storage or perfusion preservation in Celsior or University of Wisconsin solutions. Three conditions were studied: conventional static storage; static storage using either solution with 5.5 mmol/L glucose added; and perfusion preservation using either solution with 5.5 mmol/L glucose added. Glucose was provided as U-13C-labeled glucose, and glycolysis and oxidative metabolism during preservation were quantified from incorporation of (13)C into glycolytic and tricarboxylic acid cycle intermediates. Adenosine triphosphate levels after preservation, and apoptosis and cardiac function after reperfusion were measured.
Both perfusion preservation groups had higher myocardial oxygen consumption during storage and better early graft function, compared with static preservation groups (P < .05). Adenosine triphosphate levels were higher after storage in the perfusion groups (P < .01). Apoptosis was reduced in the perfusion groups (P < .01). Comparing perfusion groups, hearts preserved with Celsior had higher myocardial oxygen consumption and glucose utilization during perfusion storage and exhibited decreased reperfusion coronary vascular resistance and myocardial water content, compared with the UW perfusion group (P < .05).
Perfusion preservation results in greater metabolism during storage and superior cardiac function with improved myocyte survival, compared with static storage. Extracellular preservation solutions appear more effective for perfusion preservation, possibly by augmenting cellular metabolism.
与传统储存方法相比，机器灌注保存可改善多种实体器官的再灌注功能，但在心脏移植保存方面受到的临床关注有限。我们在具有临床相关性的保存期内，使用静态和灌注保护策略评估了具有代表性的细胞外（Celsior）和细胞内（威斯康星大学）储存液。
将大鼠心脏在Celsior液或威斯康星大学液中通过静态储存或灌注保存200分钟。研究了三种情况：传统静态储存；在两种溶液中添加5.5 mmol/L葡萄糖的静态储存；在两种溶液中添加5.5 mmol/L葡萄糖的灌注保存。葡萄糖以U-13C标记的葡萄糖形式提供，通过（13）C掺入糖酵解和三羧酸循环中间体来定量保存期间的糖酵解和氧化代谢。测量保存后的三磷酸腺苷水平以及再灌注后的细胞凋亡和心脏功能。
与静态保存组相比，两个灌注保存组在储存期间的心肌耗氧量更高，早期移植功能更好（P <.05）。灌注组储存后的三磷酸腺苷水平更高（P <.01）。灌注组的细胞凋亡减少（P <.01）。与UW灌注组相比，在灌注储存期间，用Celsior保存的心脏心肌耗氧量和葡萄糖利用率更高，再灌注时冠状动脉血管阻力和心肌含水量降低（P <.05）。
与静态储存相比，灌注保存可在储存期间实现更大的代谢，并具有更好的心脏功能和改善的心肌细胞存活。细胞外保存液似乎对灌注保存更有效，可能是通过增强细胞代谢实现的。
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