Abstract 14263: Cardiac Death Does Not Preclude Potential Donors from Heart Transplantation
Background Heart transplantation is still the gold standard for the treatment of terminal heart insufficiency. Presently the donor pool is restricted to brain death donors. Based on the lack of suitable donors for cardiac transplantation and the increasing number of patient waiting for a heart, we assessed the hypothesis that hearts from cardiac dead donors would be also suitable for transplantation.
Methods Lewis rats were either maintained brain death for 5h by inflation of a subdurally placed balloon catheter (n=6) or subjected to cardiac arrest by exsanguinations (n=6), and control donor rats (n=9) had intact hearts. Then, the hearts were excised, stored in cold preservation solution for 1h, and heterotopically transplanted. We evaluated in vivo 1.5h after transplantation left-ventricular (LV) function of the graft. Additionally histopathology and myocardial gene expression were assessed.
Results Brain death was associated with decreased LV contractility parameters (dP/dtmax: 4895±505 vs 8037±565 mmHg/s, ejection fraction, Emax and PRSW, p<0.05) and impaired cardiac relaxation (decreased dP/dtmin: 4734±575 vs 9404±550 mmHg/s and prolonged Tau, p<0.05) compared to control group. After transplantation, significantly decreased systolic function (LV systolic pressure: 63±9 vs 47±6 vs 89±5 mmHg at an intraventricular volume of 80 µl and dP/dtmax, p<0.05) and prolonged Tau (37±5 vs 35±3 vs 21±1 ms, p<0.05) were observed in both brain- and cardiac dead donor groups compared to controls. Compared with both control- and cardiac-dead donor groups, TNF-alpha, COX-2, NF-KappaB, iNOS, caspase-3 and Bax mRNA levels were significantly increased and marked inflammatory cell infiltration, oedema, necrosis, and DNA-strand breakage evidenced by TUNEL assay were observed in the myocardium of brain dead group.
Conclusions Our data demonstrate that even though the mechanisms show major differences at histological and molecular levels, cardiac dead donors show a similar outcome in cardiac function compared to brain dead donors. Especially in the times of increasing waiting lists for heart transplantations, the topic of cardiac donation after cardiac death could ease the tensed situation and should therefore be critically reevaluated in a clinical context.
- © 2012 by American Heart Association, Inc.