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document
Leukocyte-depleted reperfusion of transplanted human hearts : a randomized , double-blind clinical trial . Standard methods of myocardial preservation for heart transplantation have generally provided good results . Preservation times beyond 3 hours , however , have been associated with decreased survival . Leukocyte-mediated reperfusion injury is partly responsible for decreased graft function after prolonged graft ischemia . Leukocyte-depleted reperfusion has been shown experimentally to improve cardiac function after cold ischemic arrest . To determine the efficacy and safety of leukocyte-depleted reperfusion , 20 patients were enrolled in a randomized , double-blind clinical trial to be treated with either warm whole blood reperfusion ( group I ; n = 9 ) or warm leukocyte-depleted blood reperfusion ( group II ; n = 11 ) . Reperfusion with leukocyte-depleted blood or whole blood was carried out for 10 minutes , with enriched cardioplegic solution added for the first 3 minutes of reperfusion . The mean donor and recipient age and the ischemic time ( 142 versus 153 minutes ) were not significantly different between the two groups . Coronary sinus release of creatinine phosphokinase-MB 5 minutes after reperfusion was significantly less in group II ( 1.65 EU/min ) than in group I ( 3.83 units/min ; p = 0.05 ) . Thromboxane B2 release was also significantly less ( p = 0.05 ) in group II ( 33.6 pg/min ) than in group I ( 67.0 pg/min ) . All hearts functioned adequately in both groups . The duration of inotropic support was shorter in group II than in group I , but the difference was not statistically significant . Postoperative hemodynamics , rejection episodes , and infectious complications were also not significantly different between groups in a mean follow-up of 9 months . Mean ejection fraction 1 month after operation was 65 % in both groups . One early death occurred at 66 days secondary to infection ; two late deaths occurred in group II , both from rejection . Leukocyte-depleted reperfusion is safe and easily applied in the operating room . Furthermore , leukocyte-depleted reperfusion decreases biochemical evidence of reperfusion injury . Although not influencing postoperative cardiac function when the ischemic time is short , less than 3 hours , leukocyte-depleted reperfusion may prevent significant reperfusion injury and improve posttransplantation graft function when ischemic times are long . Safe extension of the ischemic time would expand the donor pool and allow for better crossmatching .
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Intervention_Physical
Leukocyte-depleted reperfusion
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Intervention_Physical
Leukocyte-depleted reperfusion
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Intervention_Physical
leukocyte-depleted reperfusion
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Intervention_Physical
warm whole blood reperfusion
14980
Intervention_Physical
warm leukocyte-depleted blood reperfusion
14981
Intervention_Pharmacological
Reperfusion with leukocyte-depleted blood
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Intervention_Pharmacological
whole blood
14983
Intervention_Physical
Leukocyte-depleted reperfusion
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Outcome_Mortality
survival
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Outcome_Physical
graft function
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Outcome_Physical
cardiac function
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Outcome_Other
efficacy and safety
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Outcome_Physical
ischemic time
14989
Outcome_Physical
Coronary sinus release of creatinine phosphokinase-MB 5 minutes after reperfusion
14990
Outcome_Physical
Thromboxane B2 release
14991
Outcome_Physical
hearts functioned
14992
Outcome_Physical
duration of inotropic support
14993
Outcome_Adverse-effects
Postoperative hemodynamics , rejection episodes , and infectious complications
14994
Outcome_Physical
Mean ejection fraction 1 month after operation
14995
Outcome_Adverse-effects
death
14996
Outcome_Adverse-effects
deaths
14997
Outcome_Other
safe
14998
Outcome_Physical
biochemical evidence
14999
Outcome_Physical
cardiac function
15000
Outcome_Physical
reperfusion injury
15001
Outcome_Physical
posttransplantation graft function
15002
Outcome_Physical
ischemic times
15003
Participant_Condition
Leukocyte-depleted reperfusion of transplanted human hearts :