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J Thorac Cardiovasc Surg 1995;109:1097-1102
© 1995 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

Successful survival of primates receiving transplantation with "dead,"nonbeating donor hearts

Loma Linda, Calif.

Address for reprints: Steven R. Gundry, MD, Professor and Head, Divisionof Cardiothoracic Surgery, Department of Surgery, Loma Linda University MedicalCenter, 11234 Anderson St., Loma Linda, CA 92354.

Abstract

A paucity of donor organs is the principal limitationin human heart transplantation. Prompted by our short-term studies of reanimating"dead" donor hearts in sheep, we applied the same reperfusion modificationsin juvenile baboons to determine human applications in an anoxic arrest model(as occurs when non-brain-dead patients are extubated and allowed to die).Ten juvenile baboons (mean weight 3.6 kg) were studied. Five baboons wereused as donors. After being anesthetized, donors were pretreated with methylprednisolone(Solu-Medrol), 50% dextrose, nifedipine, and prostaglandin E₁ and then paralyzed and extubated. Donors becamepulseless at 7 ± 1 minutes and had electric arrest 9 to 18 minutesafter paralysis. The five donors were left undisturbed and warm for 15, 22,30, 30, and 31 minutes, respectively, after asystole. They were then given250 ml of 4° C Roe's crystalloid cardioplegic solution via the aorticroot and the hearts were explanted into iced Euro-Collins solution. Five baboonsserved as recipients. After donor harvest, recipients were placed on cardiopulmonarybypass, given prostaglandin E₁ , and cooled to 18° C; circulatory arrest was instituted and the recipient'sheart excised. The donor heart was transplanted in an orthotopic position.Before reinstitution of bypass, 250 ml of terminal leukocyte-depleted bloodcardioplegic solution was given, then bypass was restarted and the heartswere reperfused for 60 minutes. All animals were weaned from bypass withoutthe use of inotropic agents. All animals were extubated within 2 to 4 hoursafter bypass and received standard immunosuppression. Peak creatine kinaseMB/total creatine kinase ratio was 0.2% ± 0.2%. Postoperative ejectionfractions by echocardiography were 75% to 80% (mean 76%). Animals survived1, 9, 13, 16, and 34 days, with three deaths caused by acute rejection andone each by stroke and diarrhea/dehydration. Pathologic findings showed noareas of fibrosis or ischemic damage. We conclude that successful reanimationand engraftment can be achieved with the use of the asystolic primate heart;this work suggests that human application is realistic and could greatly expand thedonor pool. (J THORAC CARDIOVASC SURG 1995;109:1097-102)

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