Donor heart preconditioning during orthotopic transplantation

Abstract

Background. To date, there are about 500 patients in the heart transplant waiting list in Ukraine. The study included 20 donors for orthotopic heart transplantation. Their average age was 32.3 years. The study evaluated the preparation of the donor heart in terms of its protection against ischemia-reperfusion injury during transplantation and the effect of donor heart preconditioning in a recipient after orthotopic heart transplantation. Тhe purpose was to evaluate the effectiveness of donor heart preconditioning for increasing myocardial resistance to ischemia-reperfusion injury and its preparation for orthotopic transplantation. Materials and methods. The work is based on the results of 20 donors who were diagnosed with brain death and authorized for the use of transplantation of human anatomical materials. Then changes in the main biochemical parameters (lactate, troponin, acid-base balance, creatinine clearance, blood glucose) and the functional state of systemic hemodynamics (blood pressure, heart rate, central venous pressure, ejection fraction, cardiac index) were analyzed at the time of donor heart explantation. Results. It was found that in 100 % of donors, norepinephrine was used for inotropic support, in 40 % — dobutamine and in 25 % — dopamine. Lactate levels were higher than normal in 75 % of cases and troponin levels were increased in all donors, indicating a possible microcirculatory dysfunction that led to a deterioration in donor preconditioning and enhanced ischemia-reperfusion injury to the transplant. According to the correlation coefficient between time and cardiac index, there was a tendency to the deterioration in the donor’s condition depending on the time of making a decision about heart transplantation before heart explantation. Conclusions. The study showed that in 100 % of donors, norepinephrine was used for inotropic support — more often than dobutamine or dopamine. Lactate levels were higher than normal in 75 % of donors and troponin levels were increased in all donors, indicating a possible microcirculatory dysfunction that led to a deterioration in donor preconditioning and increased ischemia-reperfusion injury to the transplant. According to the correlation coefficient between time indicators and cardiac index, it is noted that the longer the time of authorization for orthotopic heart transplantation, the greater the deterioration in the donor’s condition, which is expressed in a decreased myocardial contractility. Based on the correlation coefficient between time indicators and troponin, it was concluded that the growth of troponin complexes was observed with an increase in the time of making a decision for obtaining permission to transplant human anatomical materials, which indicated the onset of ischemic changes in the myocardium.