University of Wisconsin solution versus Celsior solution in clinical pancreas transplantation

INTRODUCTION: This study compared the safety and efficacy of University of Wisconsin solution (UW) and Celsior solution (C) in pancreas transplantation (PTx). METHODS: A retrospective review of 154 PTx performed over a 61-month period included 77 grafts preserved with UW and 77 with C. The two groups were comparable for both donor and recipient characteristics. RESULTS: After a mean cold ischemia time of 624 minutes (range 360 to 945 minutes) for UW versus 672 minutes (range 415 to 1005 minutes) for C (P = NS), no primary endocrine nonfunction occurred. Delayed endocrine function was diagnosed in two grafts in the UW group (2.6%) versus none in the C group (P = NS). After a minimum follow-up of 4 months (mean 26.5 +/- 15.2 months), 22 recipients (UW = 11 vs C = 11; P = NS) required relaparotomy. Overall, 18 pancreata were lost due to either patient death with functioning graft (UW = 4 vs C = 1; P = NS) or graft loss due to other reasons (UW = 8 vs C = 5; P = NS). Actuarial 1- and 5-year patient survival rates were 93.5% and 86.8% for UW compared with 98.7% and 98.7% for C (P = .04). Actuarial graft survival rates at the same times were 88.3% and 75.0% for UW compared with 90.4% and 90.4% for C (P = NS). CONCLUSIONS: Within the range of cold ischemia times reported in this study, UW and C show similar safety and efficacy profiles for PTx.     

Advantages of Celsior solution in graft preservation from non-heart-beating donors in a canine liver transplantation model.

BACKGROUND: The optimal method for preserving livers from non-heart-beating donors (NHBD) is still unknown. We compared the Celsior solution, a new extracellular-type, low-potassium, low-viscosity preservation solution, with the University of Wisconsin (UW) solution in a canine orthotopic liver transplantation from NHBD. MATERIALS AND METHODS: Fourteen adult mongrel dogs, weighing 9 to 17 kg, were divided into two groups: the Celsior or the UW group (n = 7 each). The thoracic descending aorta and supradiaphragmatic inferior vena cava were cross-clamped for 20 min to induce warm ischemia as a NHBD model. The liver was flushed with the respective cold preservation solution and then stored at 4 degrees C for 4 h. The grafts were transplanted using the piggy-back technique under portal decompression by leaving the native right lobe as a temporary shunt. RESULTS: The duration of liver flushing out (min) was shorter (P < 0.05), and the serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, lactate dehydrogenase, lactate, and alpha-glutathione S-transferase concentrations 2 and 6 h after reperfusion of the graft (RPF) were lower (P < 0.05) in the Celsior group than in the UW group. Hepatic tissue blood flow (HTBF) did not deteriorate as much (P < 0.05) in the Celsior group. The serum endothelin-1 level was lower (P < 0.05) in the Celsior group 2 h after RPF. Histopathology of liver specimens revealed portal congestion and hepatocyte necrosis with neutrophil infiltration in the UW group, while these findings were mild in the Celsior group. CONCLUSIONS: The Celsior solution improves vascular endothelial injury in livers from NHBDs and may have advantages in graft flush and preservation of grafts from NHBDs.     

Celsior液中HGF对大鼠肝移植后INF-γ、IL-4与IL-10水平的影响

目的 探讨Celsior(CS)液中添加重组人肝细胞生长因子(recombinant human hepato-cyte growth factor,rhHGF)对大鼠肝移植后INF-γ、IL-4与IL-10水平的影响.方法 利用无心跳供肝(non-heart beating donor,NHBD)大鼠肝移植模型,ELISA法检测实验组(CS添加rhHGF)和对照组(CS添加生理盐水)门静脉再通1h血清INF-γ、IL-4与IL-10水平,逆转录聚合酶链反应(RT-PCR)测定肝组织INF-γ、IL-4与IL-10 mRNA水平,并观察肝组织病理及大鼠牛存率.结果 与对照组相比,试验组NHBD供肝移植后在门静脉再通1 h后血清INF-γ水平及肝组织INF-γ mRNA水平明显低于对照组(P<0.05),血清IL-4与IL-10水平及相应肝组织IL-4与IL-10 mRNA水平明显高于对照组(P<0.05),实验组大鼠生存率明显高于对照组(P＜0.05),病理组织学提示实验组肝细胞水肿变性减轻,无明显肝细胞坏死、肝窦淤血及门静脉充血.结论 CS灌注保存液中添加外源性rhHGF可改善其对NHBD供肝的保存效果,提高术后生存率,这可能与其下调INF-γ,上调IL-4与IL-10的产生有关.     

Celsior solution provides superior post-ischemic right ventricular function as compared with UW solution in a porcine heart transplantation model.

BACKGROUND: Use of the new cardioprotective Celsior solution has been suggested for organ preservation in cardiac transplantation, but selective data for right ventricular function, of special interest in the clinical setting, have not been evaluated. METHODS: Celsior solution was compared with the clinical standard University of Wisconsin solution (UW) in a porcine allogenic heart transplantation model with accurate isovolumic measurement of right ventricular (RV) function. RESULTS: Maximum RV developed pressures were significantly different between Celsior and UW groups (51.1 +/- 9.6 mm Hg vs 42.2 +/- 15.4 mm Hg after 1 hour, respectively, and 55.6 +/- 7.8 mm Hg vs 45.1 +/- 16.2 mm Hg after 2 hours, respectively; p = 0.02, 2-way analysis of variance). CONCLUSIONS: Celsior significantly improves post-ischemic right ventricular function when compared with UW solution in an experimental heart transplantation model.     

Preservation of the liver graft with Celsior solution

INTRODUCTION: We studied the evolution of the liver graft with preservation in Celsior (CS) compared with University of Wisconsin solution (UW). MATERIAL AND METHODS: A randomized prospective clinical study in 80 liver transplants (OLTs) from May 2001 to October 2003, compared CS (group I; n = 40) and UW (group II; n = 40). The characteristics of the donors were homogeneous, with no significant differences in 15 variables. CS was perfused with 4 L through the aorta, 2 L through the portal vein, and 1 L, through the portal vein on the back table; and the UW, as 3 L, 2 L, and 1 L, respectively. All OLTs were performed using the piggyback technique. RESULTS: Group I experienced reperfusion syndrome (n = 2; 5.9%), primary graft nonfunction (n = 0); vascular complications (n = 0); biliary anastomosis stenosis (n = 8; 22.9%), intensive care unit (ICU) days (n = 4.1 +/- 1), death within 30 days (n = 1; 3.1%). The patient and graft survivals at 1, 3, 6, 12, and 24 months were 93.7%, 93.7%, 90.2%, 85.7%, 85.7%, and 94.3%, 88.5%, 85.2%, 78%, 78%, respectively. For group II; the reperfusion syndrome occured in 6 patients (17.6%); primary graft nonfunction (n = 0); vascular complications (n = 0), biliary anastomosis stenosis (n = 3; 8.6%), ICU days (n = 4.9 +/- 2.4) and death within 30 days (n = 1; 3.1%); The patient and graft survival at 1, 3, 6, 12, and 24 months were 96.9%, 93.5%, 89.8%, 79.8%, 79.8% and 94.3%, 88.3%, 84.9%, 75.5%, 66.1%, respectively. CONCLUSIONS: CS offers the similar safety to UW for preservation of liver grafts within these ischemia times.     

小型猪小体积肝移植模型的建立

目的研究构建成熟稳定小型猪小体积肝移植模型的方法。方法选用体重一致的广西巴马小型猪20只,按照随机原则分为供体组和受体组各10只。在获取供肝的过程中即进行减体积操作,切除左半肝并保留肝中静脉主干。受体采用经典原位非静脉-静脉转流法行小体积肝移植。记录受体肝移植的手术时间,供肝热缺血时间、冷缺血时间,受体无肝期时间。观察移植术后2周存活情况及手术相关并发症。结果手术时间5～7h,平均6h;供肝热缺血时间2～3min;冷缺血时间(116±16)min;无肝期时间(35±4)min。术中小型猪均无死亡。10只受体猪中,2只死于手术相关并发症,其中1只于术后10h死于肝断面出血,另1只于术后2d死于切口疝。其余8只受体猪皆存活超过2周,2周存活率达80%,均未发生手术相关并发症。结论在供体手术中切除左半肝并保留肝中静脉主干,受体采用经典原位非静脉-静脉转流法行小型猪小体积肝移植模型构建是可行且稳定的。     

Protective effects of Celsior in lung transplantation.

BACKGROUND: Celsior is a new preservation solution for heart transplants that recently has been shown also to improve protection of pulmonary grafts. As these data were obtained in isolated lung preparations, we sought to perform further tests with an in vivo model of allogeneic lung transplantation. METHODS: The left lungs of 41 rats were either transplanted immediately after harvest (controls) or flushed with and cold stored in Celsior or the blood-based Wallwork solution for 5 or 12 hours. Lungs were then reperfused for 30 minutes, after which ligation of the contralateral pulmonary artery and bronchus made the recipient rat exclusively dependent on the transplanted lung. Assessment of preservation was made on functional (blood gases, pulmonary hemodynamics) and structural (dry-to-weight ratio, light microscopy, myeloperoxidase [MPO] content) end points. RESULTS: The protective effects of Celsior were primarily manifest, once the contralateral lung had been functionally excluded, as a better preservation of oxygen tensions in the 5-hour storage experiments (416 +/- 52 mm Hg vs 406 +/- 59 mm Hg in controls [p = NS] and vs 239 +/- 34 mm Hg in Wallwork [p < 0.05 vs the 2 other groups]) and a smaller increase in pulmonary vascular resistance in the 12-hour storage experiments (10.2 +/- 4.1 mm Hg/mL/minute vs 3.2 +/- 1.1 mm Hg/mL/minute in controls [p = NS] and vs 23.1 +/- 4.3 mm Hg/mL/minute in Wallwork [p < 0.02 vs Celsior, p < 0.002 vs controls]). Survival was also longer in the 12-hour preserved Celsior group. Other end points were not significantly different between the two preservative solutions. CONCLUSION: These data support the efficacy of Celsior as a flush-out and storage solution for pulmonary grafts. Given its previously documented ability to adequately preserve heart transplants, Celsior might provide a unified "solution" to thoracic organ preservation.     

Lipid peroxidation in ischemia-reperfusion oxidative injury of the graft preserved in Celsior and University of Wisconsin solutions on a pig pancreas transplantation model

BACKGROUND: Graft pancreatitis (GP) is one the main technical problems associated with pancreas transplant (PT). It occurs in 20% of patients representing a risk factor for thrombosis and cause of graft loss. GP is related to oxidative effects from oxygen-derived free radicals (OFR) in ischemia-reperfusion injury. We evaluated lipid peroxidation by the OFR in the PT of pig organs preserved with either Celsior or Wisconsin solutions. METHODS: In Landrace pigs we performed 24 pancreas allografts, which were preserved 18 or 24 hours: 12 with Celsior solution (CS) and 12 with Wisconsin solution (UW). No immunosuppression was administered. The oxidative effects were determined by quantification of malondialdehyde (MDA) and 4-hydroxyalkenals (4-HDA) and of the carbonyl groups of proteins in our pancreatic tissue samples and measured at different times: (A) baseline in the donor, (B) after perfusion of the graft, (C) after the ischemia period, and (D) 30 minutes after ischemia-reperfusion of the graft. RESULTS: The MDA and 4-HDA values were similar in conditions A, B, and C, but showed an extraordinary increase after ischemia-reperfusion in D, among both the 18- or 24-hour preserved grafts and in the same proportion with CS and UW. The carbonyl groups of the proteins rose in conditions B and C (cold ischemia), but less so in state D (reperfusion). CONCLUSIONS: The oxidative injury of a pancreatic graft preserved for 18 or 24 hours occurs during reperfusion, with an extraordinary intensity, but similarly with CS and UW, an observation that may help to explain graft pancreatitis.     

Radiofrequency ablation lesions in a pig liver model.

BACKGROUND: Radiofrequency (RF) ablation has been reported as a means of liver tumor destruction. This study evaluates the use of ultrasound monitoring of radiofrequency lesion creation and describes the morphology, histologic characteristics, and vascular effects of radiofrequency ablations in a pig liver model. MATERIALS AND METHODS: Hemodynamic monitoring was established and laparotomies were performed in 50-kg pigs. Under ultrasound guidance, radiofrequency needle probes were placed in the liver at predetermined locations. Radiofrequency energy was applied over 15 min to generate lesions 3 cm in diameter. Eighty lesions were generated in 10 animals. At the completion of the experiment, the lesions were examined with ultrasound and then excised for CT, gross, and histologic examination. RESULTS: There were no adverse systemic effects. Ultrasound imaging demonstrated the size, shape, and position of the lesions. Gross examination demonstrated a core of ablated tissue with a surrounding 1- to 2-mm hemorrhagic perimeter. Lesion volumes averaged 12.8 cc(3) (range 5-34 cc(3)). Final lesion shape and size were frequently altered by the cooling effect of local blood flow. Histologic stains demonstrated microvascular thrombosis and coagulative necrosis within the lesions. There appeared to be 100% cellular destruction within the lesion by cytochemical staining. CONCLUSIONS: We demonstrated that RF ablation is capable of killing large volumes of normal liver tissue; however, local vasculature plays a significant a role in defining the ultimate size and shape of the lesion created. This may interfere with the utility of radiofrequency ablation as a modality for local tumor control.     

Exchange transplantation of the liver in the pig.

An original technique is described for exchange transplantation of the liver in the pig. The procedure also allows a complete autograft to be performed with the same operative trauma as a transplant. The initial problems that were encountered, but overcome in both autografts and transplants, included difficulty with adequate perfusion of the liver in the live animals, gas gangrene resulting from hepatic arterial thrombosis in animals under 22 kg, and fear of devascularisation of the pancreas or stomach during dissection. In this series, six successful pairs of pigs were transplanted and, in three pairs, one animal showed severe rejection and early death while the other lived longer with a different response. The technique has significant immunological and economical potential.