Abstract

Background:With the increasing success of heart transplantation, older and higher-risk donors and recipients are being accepted for transplantation. The risk of primary graft dysfunction (PGD) is thus increased. We investigated a 'pharmacological conditioning' strategy, where Celsior preservation solution supplemented with glyceryl trinitrate (GTN) and erythropoietin (EPO) was used for cardioplegia and hypothermic storage, and determined graft recovery and patient survival after cardiac transplantation. Methods:Donor hearts retrieved between August 2010 and November 2013 were arrested and stored with supplemented Celsior (n = 61). Historical comparisons were made with hearts stored in Celsior (April 2005 to July 2010; n = 104) and modified St. Thomas' solution (STS, January 2000 to March 2005; n = 100). Donor, recipient and procedural risk factors for PGD were determined, and post-transplant use of mechanical circulatory support (MCS), length of stay (LOS) and 12-month survival compared between groups. Results:Fewer hearts stored in STS came from donors aged > 50 years (p < 0.01). Recipients of hearts stored in supplemented Celsior had increased use of MCS pre-transplant (36%, p < 0.0001), and increased cross clamp times during implantation (111 min, p < 0.0001). Use of MCS post-transplant was 32.0%, 31.7% and 24.6% in STS, Celsior and supplemented Celsior groups respectively. There were no differences in LOS. Survival at 1-month was 92%, 95% and 98% and at 12-months 86%, 89% and 90% respectively. Conclusion:Despite an increased donor and recipient risk profile, supplemented Celsior was associated with excellent operative and 12-month survival. There was a trend towards decreased need for post-transplant MCS, however the incidence of PGD remains high.

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