Preservation solution in heart transplantation

Abstract

Acute graft failure still accounts for approximately 20–30% of early deaths after heart transplantation [1, 2]. This complication is clearly multifactorial. Thus, some of these failures can be related to the status of the donor heart (unrecognized existence of parietal and/or coronary abnormalities, hemodynamic instability at the time of harvest). At the opposing end of the sequence of events that the graft must go through, implantation and early reperfusion are critical steps during which damage can be induced by suboptimal preservation techniques. Nevertheless, it is usually admitted that most of this damage occurs during the ex-vivo transportation period. Theoretically, this damage could be avoided by continuous perfusion of the graft with blood or oxygenated crystalloid solution. For practical reasons, however, these perfusion techniques have not gained clinical acceptance and static immersion in hypothermic media remains the cornerstone of organ preservation. Consequently, the following remarks will focus on the principles of formulation and clinical applications of these solutions designed for initial arrest and subsequent storage of donor hearts.