Koerner M M, Tenderich G, Minami K, Morshuis M, Mirow N, Arusoglu L, Gromzik H, Wlost S, Koerfer R
Heart Center Northrhine-Westphalia, University Hospital of the Ruhr University of Bochum, Bad Oeynhausen, Germany.
Transplantation. 1997 May 15;63(9):1358-60. doi: 10.1097/00007890-199705150-00027.
An increasing demand for cardiac allografts for the treatment of end-stage cardiac failure has led to a shift in the traditional views about donor criteria. The use of allografts exposed to high concentrations of carbon monoxide is still under discussion. The current literature on this topic is contradictory. We describe our experience with orthotopic cardiac transplantation, using cardiac allografts after carbon monoxide poisoning.
Between March 13, 1989 and August 1, 1996, 770 orthotopic heart transplantations were performed in our center. Within this period, we accepted five cardiac allografts from brain-dead, carbon monoxide-poisoned donors. Donor history showed carbon monoxide intoxication in all cases. At the time of organ explantation, donor hemodynamic parameters were feeble in all patients.
The postoperative course was uneventful in three of the five recipients. The overall 3-year survival rate in this small group is 40%. Induction therapy or rescue therapy with mono/polyclonal antibodies was not necessary. Myocardial right-ventricular biopsies did not show any specific signs of carbon monoxide poisoning.
In our opinion, cardiac allografts from donors exposed to carbon monoxide can be transplanted successfully in infants and adults, if there are no signs of severe hemodynamic dysfunction in the presence of a normal central venous pressure and low-dose support with catecholamines and there are no electrocardiographic changes in combination with elevated transaminase. With extended donor criteria, the hearts of carbon monoxide-poisoned victims could increase the number of suitable organs and lower the death rate of patients on the United Network for Organ Sharing and Eurotransplant International Foundation waiting lists.
用于治疗终末期心力衰竭的心脏同种异体移植物需求不断增加，这导致了对供体标准的传统观念发生转变。暴露于高浓度一氧化碳的同种异体移植物的使用仍在讨论中。关于这一主题的当前文献相互矛盾。我们描述了使用一氧化碳中毒后的心脏同种异体移植物进行原位心脏移植的经验。
1989年3月13日至1996年8月1日期间，我们中心进行了770例原位心脏移植手术。在此期间，我们接受了5例来自脑死亡、一氧化碳中毒供体的心脏同种异体移植物。供体病史显示所有病例均有一氧化碳中毒。在器官摘取时，所有患者的供体血流动力学参数均很微弱。
5名受者中有3名术后过程顺利。这个小群体的总体3年生存率为40%。不需要使用单克隆/多克隆抗体进行诱导治疗或挽救治疗。右心室心肌活检未显示一氧化碳中毒的任何特定迹象。
我们认为，如果在中心静脉压正常且使用小剂量儿茶酚胺支持的情况下没有严重血流动力学功能障碍的迹象，并且没有转氨酶升高伴心电图改变，那么来自一氧化碳中毒供体的心脏同种异体移植物可以在婴儿和成人中成功移植。随着供体标准的扩大，一氧化碳中毒受害者的心脏可以增加合适器官的数量，并降低器官共享联合网络和欧洲移植国际基金会等待名单上患者的死亡率。
