Abstract

The use of hearts with left-ventricular (LV) hypertrophy (LVH) could offer an opportunity to extend the donor pool for cardiac transplantation. We assessed the effects of LVH in 18-month-old spontaneously hypertensive stroke-prone (SHRSP) donor rats and following transplantation. In donors, cardiac function and structural alterations were assessed. Then, the hearts were transplanted into young normotensive-rats. We evaluated LV graft function 1 h after transplantation. The myocardial expression of 92 genes involved in apoptosis, inflammation, and oxidative-stress was profiled using PCR-array. Compared to controls, SHRSP-rats developed LVH, had increased LV systolic performance (slope of the end-diastolic pressure-volume (PV) relationship: 1.6±0.2 vs 0.8±0.1mmHg/μl, p<0.05) accompanied by diastolic dysfunction [prolonged time constant of LV pressure decay (Tau: 15.8±0.6 vs 12.3±0.5ms) and augmented diastolic stiffness (LV end-diastolic PV relationship: 0.103±0.012 vs 0.045±0.006mmHg/ml), p<0.05]. They presented ECG changes, myocardial fibrosis, and increased nitrotyrosine immunoreactivity and plasma troponin-T and creatine kinase-CM levels. After transplantation, even though the graft contractility was better in SHRSP rats compared to controls, the adverse impact of ischemia/reperfusion-injury on contractility was not altered (Ees ratio after versus before transplantation: 32% vs 29%, p>0.05). Whereas nitrotyrosine immunoreactivity was higher, myeloperoxidase-positive cell infiltration was decreased in the SHRSP+transplanted compared to control+transplanted. Among the tested genes, LVH was associated with altered expression of 38 genes in donors, while transplantation of these hearts resulted in the change of four genes. Alterations in 18-month-old donor hearts, as a consequence of hypertension and LVH, were not associated with graft dysfunction in the early phase of reperfusion after transplantation.

Highlights

  • Heart transplantation is the current curative treatment option for end-stage heart failure

  • spontaneously hypertensive stroke-prone (SHRSP) rats develop LVH, which was confirmed by significantly increased heart weight-to-body weight ratio, increased cardiomyocyte diameter normalized to body weight, and increased LV mass index

  • We investigated the effect of LVH on early post-transplant changes at functional levels and analyzed gene expression profiles in the hearts of 18month-old SHRSP rats

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Summary

Introduction

Heart transplantation is the current curative treatment option for end-stage heart failure. The imbalance between waiting lists and surgery rates continuously increases due to higher demand with no increase in the supply of suitable organs. Adequate and optimal utilization of the donor pool is essential. Efforts have been made to expand donor acceptance criteria by using socalled “appropriate marginal” donors, who would be declined under conventional transplant guidelines. The concept of marginal donors consists of donors who are older, have hepatitis C virus-positivity, a history of alcoholism, diabetes mellitus, an ejection fraction 55 years, left ventricular (LV) hypertrophy (LVH) >1.3 cm, and LV ejection fraction ≤50%

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