Orthotopic allotransplantation and autotransplantation of the baboon heart following 24-hr storage by a portable hypothermic perfusion system

A nonpulsatile perfusion apparatus, based on the air-lift pump principle, has been developed. Circulation of the perfusate, as well as oxygenation and maintenance of acid-base balance, is provided by the flow of a mixture of 97% oxygen and 3% carbon dioxide. The system is easily and entirely portable. Eleven baboons underwent orthotopic allotransplantation with donor hearts stored by continuous hypothermic (4-10 degrees C) perfusion for periods of up to 24 hr. Three were electively killed after 2 to 3 days; the remaining eight, immunosuppressed with methylprednisolone and either azathioprine or cyclosporin A, survived to rejection at between 10 and 49 days. Cardiac catheterization performed in six animals 7-14 days after allotransplantation showed virtually normal hemodynamic data. Three more baboons underwent heart excision and storage by hypothermic perfusion for 24 hr, and subsequent othotopic autotransplantation, the circulation of the baboon being maintained in the interim by an allograft. One animal survives 8 months later with hemodynamic data at cardiac catheterization differing little from that obtained before autotransplantation. This perfusion system has subsequently been used to store four human donor hearts prior to heterotopic transplantation.     

The application of fluidics technology for organ preservation

A prototype design of a portable, pulsatile, perfusion preservation device based on a novel application of fluidics technology was tested to evaluate its ability to oxygenate preservation solution and to examine the relationship between organ resistance, perfusion pressure, and perfusion flow characteristics. The effects of organ resistance on pulse rate, perfusion pressure, and perfusion flow were modeled. Interstitial PO2 in canine hearts stored at 4 degrees C for 12 hours in the fluidics device (n = 5) and in static hypothermic storage (n = 5) was also compared. Increasing outflow resistance did not have an effect on operating frequency of the fluidics actuator. Perfusion pressure rose as outflow resistance was increased, and the flow of preservation solution decreased proportionately. The PO2 of the preservation solution increased to 300 mm Hg in two hours and reached a plateau that exceeded 400 mm Hg within six hours. The aortic flow profile during pulsatile perfusion resembled a square wave function with a mean pulse duration of 0.30 +/- 0.05 seconds. Oxygen delivery by the fluidics perfusion device exceeded the oxygen requirements of the hypothermically preserved organs at all resistance levels. Initial interstitial PO2 in the hearts of both groups was greater than 150 mm Hg. In perfused hearts, PO2 declined 30% by the 12th hour, whereas complete depletion of oxygen was noted in the static storage group within six hours. The fluidics organ perfusion/transport apparatus weighs less than 18 kg, uses no electrical power, and can operate continuously for 10 to 12 hours expending 780 L of oxygen.     

Improved cardiac function following hormonal therapy in brain dead pigs: relevance to organ donation

Deterioration of function in brain dead baboons is associated with depletion of both myocardial energy stores and certain circulating hormones, notably thyroxine, cortisol, and insulin. We have therefore investigated the effect of the administration of these three hormones to the brain dead pig; their value has been assessed on both the freshly excised and stored donor heart. Brain death was induced by ligation of the two arteries to the upper part of the body which arise from the aortic arch. Storage of selected hearts was by continuous hypothermic perfusion for 20 to 24 hr. Hearts were biopsied for estimation of adenosine triphosphate, creatine phosphate, lactate, and glycogen, and were subsequently functionally tested. Six groups of pigs were studied. Hearts were tested from control pigs which had not undergone brain death (A1), from brain dead pigs which had received intravenous fluid and inotropic support for 4 hr (B1), and from brain dead pigs which had in addition received 2 hr of hormonal therapy (thyroxine 2 micrograms cortisol 100 mg, and insulin 5-10 IU hourly) (C1). A further 3 groups (A2-C2) underwent management identical to A1-C1, but in addition the hearts were stored for 24 hr. Brain death in pigs was followed by a consumption of myocardial energy stores, despite anaerobic glycolysis; this was associated with reduced myocardial function. The administration of hormones to the brain dead pig led to some replenishment of myocardial energy and glycogen reserves and reduction in lactate, with associated improvement in hemodynamic function. A period of hypothermic perfusion storage appeared to reverse the anaerobic metabolism occurring in the heart in the nonhormonally treated brain dead animal, though not in the hormonally treated animal, and led to replenishment of glycogen reserves in nontreated animals. The observation that both better function and an increase in myocardial energy stores occurred in hormonally treated, stored hearts, even though perfusate lactate dehydrogenase rose to significantly higher levels during hypothermic perfusion storage, and tissue lactate levels remained high, suggests that thyroxine promotes both aerobic and anaerobic metabolism in brain dead animals.     

Role of the fuel utilized by tissues on coronary vessel response to physical stimuli in isolated rat hearts

In isolated rat hearts which can or cannot utilize fatty acids (FA) as substrates the coronary responses to an increase in flow were studied under three different conditions: a) control, during perfusion with glucose-enriched Tyrode solution which allowed the hearts to utilize long-chain FA from the endogenous pool, b) during forced utilization of glucose obtained with oxfenicine, an inhibitor of long-chain FA oxidation, and c) during restored utilization of FA obtained with the addition of hexanoic acid which bypasses the blockade induced by oxfenicine. A step increase in coronary flow (50 %) induced an increase in coronary perfusion pressure whose initial slope (first 60-80 s) was similar in all the conditions of buffer perfusion, thereafter the pressure tended to further increase under control conditions (buffer a), but to decrease during oxfenicine (buffer b). The addition of hexanoic acid to the perfusion solution (buffer c) abolished the effect of oxfenicine. Steady-state conditions were reached after four minutes of increased flow, when perfusion pressure increased by about 70 and 65 % under control conditions and during hexanoate, respectively, but only by 45 % during oxfenicine. In isolated rat hearts during inhibition of FA utilization, an increase in flow elicited a reduced increase in perfusion pressure that resulted in delayed coronary dilation. It follows that the resulting shear stress is substrate-sensitive.     

Effect of enhanced red blood cell aggregation on blood flow resistance in an isolated-perfused guinea pig heart preparation

The role of red blood cell (RBC) aggregation as a determinant of in vivo blood flow is still unclear. This study was designed to investigate the influence of a well-controlled enhancement of RBC aggregation on blood flow resistance in an isolated-perfused heart preparation. Guinea pig hearts were perfused through a catheter inserted into the root of the aorta using a pressure servo-controlled pump system that maintained perfusion pressures of 30 to 100 mmHg. The hearts were beating at their intrinsic rates and pumping against the perfusion pressure. RBC aggregation was increased by Pluronic (F98) coating of RBC at a concentration 0.025 mg/ml, corresponding to about a 100% increment in RBC aggregation as measured by erythrocyte sedimentation rate. Isolated heart preparations were perfused with 0.40 l/l hematocrit unmodified guinea pig blood and with Pluronic-coated RBC suspensions in autologous plasma. At high perfusion pressures there were no significant differences between the flow resistance values for the two perfusates, with differences in flow resistance only becoming significant at lower perfusion pressures. These results can be interpreted to reflect the shear dependence of RBC aggregation: higher shear forces associated with higher perfusion pressures should have dispersed RBC aggregates resulting in blood flow resistances similar to control values. Experiments repeated in preparations in which the smooth muscle tone was inhibited by pre-treatment with papaverine indicated that significant effects of enhanced RBC aggregation could be detected at higher perfusion pressures, underlining the compensatory role of vasomotor control mechanisms.     

A simplified isolated perfused rat liver apparatus: characterization and measurement of extraction ratios of selected compounds

A simplified isolated perfused rat liver (IPRL) preparation has been developed and evaluated. The liver is briefly perfused in situ prior to being placed into a 37 degrees C oven and suspended from a stand. This set-up takes about 5 min. A non-recirculatory or one-pass perfusion approach has been used. The performance of the apparatus was evaluated with use of three model compounds: antipyrine, lidocaine and ethanol. In addition, oxygen extraction was determined. The steady-state extraction ratio (ER) was determined for each compound (and oxygen) as a function of perfusate flow rate (15-35 ml/min) during sequential 45 min perfusion periods. Perfusion experiments lasted for up to 3 hr. The ERs (at 15 ml/min) of ethanol (0.65 +/- 0.15), lidocaine (0.91 +/- 0.01) and oxygen (0.65 +/- 0.10) were dependent upon perfusate flow; whereas, antipyrine ER (0.07 +/- 0.01) was independent of flow. The corresponding values for unbound intrinsic clearances (CLu,int) for antipyrine, ethanol, lidocaine and oxygen were: 1.6, 31.0, 158.0 and 27.5 ml/min, respectively. These findings are consistent with the known hepatic ER values for those compounds reported in the literature.     

In vitro study of functional parameters and cardiac arrhythmia in localized ischemia followed by reperfusion in two rat strains (Sprague Dawley and Wistar)

The cardiac parameters of two rat strains [Wistar (W) and Sprague Dawley (SD)] were compared during Langendorff perfusion. The values of coronary flow, heart rate, amplitude of contraction and the incidence of arrhythmias were studied during three 10 minutes periods: perfusion, ischemia by coronary artery occlusion and reperfusion. The values of heart rate and coronary flow of SD hearts are always higher than those of W hearts whatever the potassium (K+) concentration of perfusate (5.9 or 3 mM). Furthermore, with a high K+ perfusate (5.9 mM) and during ischemia. W rat hearts showed ventricular tachycardia periods which are never observed in SD rat hearts. It is concluded that W rat hearts present a higher sensitivity to the development of dysfunction than SD rat hearts.     

Forty-eight hours hypothermic pulsatile perfusion of canine hearts before transplantation.

Canine hearts preserved for 24 hr under hypothermic pulsatile perfusion had a good function after transplantation. The perfusate consisted of cryoprecipitated plasma that was modified by the addition of salt poor albumin, potassium chloride and glucose; the final osmolarity was 340 mOsm/L. Fresh allografts without perfusion survived for an average of two weeks after transplantation, and the 24 hr perfused hearts survived for more than 19 days after transplantation. When the perfusion was extended to 48 hr, the survival was decreased to 11 days. These data indicate that hypothermic pulsatile perfusion is completely safe and feasible for 24 hr without significant functional or histological impairment. The survival response of the hearts perfused for 48 hr was significantly decreased when compared to the hearts perfused for 24 hr.     

The coronary vasodilator mediator released by hypoxia and isoprenaline is not affected by cyclo-oxygenase inhibition

Donor and recipient guinea-pig hearts were perfused in series, the recipient being perfused with regassed donor effluent. Coronary perfusion pressure and force and rate of contraction were measured. Exposure of donor hearts to hypoxia (1.5 min) and to isoprenaline (5 ng) caused the appearance of vasodilator material in recipient hearts, the direct beta-adrenoceptor effects of isoprenaline carried over in the effluent being antagonized in the recipient by propranolol. Cyclo-oxygenase was inhibited by infusion of meclofenamate (60 micrograms X min-1) which consistently abolished the vasodilator responses to arachidonic acid added to the donor. The vasodilator responses of the donor to hypoxia and isoprenaline were unaffected by meclofenamate. The falls in perfusion pressure of the recipient in response to material released by these procedures were also not significantly different before (hypoxia, 11.5 +/- 2.6mm Hg; isoprenaline, 10.3 +/- 1.3mm Hg) and during the infusion (hypoxia, 10.2 +/- 4.1; isoprenaline, 11.0 +/- 1.3mm Hg). The coronary vasodilator responses to hypoxia and isoprenaline and the vasodilator material released by these procedures do not therefore appear to be due to products of arachidonic acid via cyclo-oxygenase pathways. Furthermore, since there was also no potentiation of the responses, there does not appear to be a concomitant release of a prostanoid to inhibit the major vasodilator material. Adenosine, as the likely candidate for this predominant vasodilator mediator, is discussed.     

An apparatus to study the response of cultured endothelium to shear stress

An apparatus which has been developed to study the response of cultured endothelial cells to a wide range of shear stress levels is described. Controlled laminar flow through a rectangular tube was used to generate fluid shear stress over a cell-lined coverslip comprising part of one wall of the tube. A finite element method was used to calculate shear stresses corresponding to cell position on the coverslip. Validity of the finite element analysis was demonstrated first by its ability to generate correctly velocity profiles and wall shear stresses for laminar flow in the entrance region between infinitely wide parallel plates (two-dimensional flow). The computer analysis also correctly predicted values for pressure difference between two points in the test region of the apparatus for the range of flow rates used in these experiments. These predictions thus supported the use of such an analysis for three-dimensional flow. This apparatus has been used in a series of experiments to confirm its utility for testing applications. In these studies, endothelial cells were exposed to shear stresses of 60 and 128 dynes/cm2. After 12 hr at 60 dynes/cm2, cells became aligned with their longitudinal axes parallel to the direction of flow. In contrast, cells exposed to 128 dynes/cm2 required 36 hr to achieve a similar reorientation. Interestingly, after 6 hr at 128 dynes/cm2, specimens passed through an intermediate phase in which cells were aligned perpendicular to flow direction. Because of its ease and use and the provided documentation of wall shear stress, this flow chamber should prove to be a valuable tool in endothelial research related to atherosclerosis.     

Protection of the ischemic diabetic heart by L-propionylcarnitine therapy

Diabetics suffer from an increased incidence of myocardial infarction and are less likely to survive an ischemic insult. Since L-propionylcarnitine (LPC) has been shown to protect against ischemic/reperfusion injury, we hypothesized that LPC may be of even greater benefit to the diabetic heart. Diabetes was induced by i.v. streptozotocin, 60 mg/kg; duration: 12 wks. The chronic effect of LPC was determined by daily i.p. injections (100 mg/kg) for 8 wks. The acute effects of LPC were determined by adding it to the perfusion medium (5 mM) of control and diabetic hearts. Initial cardiac contractile performance of isolated perfused working hearts was assessed by varying left atrial filling pressure. Hearts were then subjected to 90 min of low flow global ischemia followed by 30 min reperfusion. Chronic LPC treatment had no effect on initial cardiac performance in either control or diabetic hearts. Acute addition of LPC to the perfusion medium enhanced pump performance of control hearts, but had no effect in diabetic hearts. Both acute and chronic LPC significantly improved the ability of control and diabetic hearts to recover cardiac contractile performance after ischemia and reperfusion, however, chronic treatment was more effective in diabetic hearts.     

An evaluation of colloidal solutions for normothermic perfusion of rabbit hearts: An improved perfusate containing Haemaccel

Rabbit hearts were perfused at 37 °C with the aim of establishing a relatively simple and preferably synthetic perfusate which would give reliable and consistent perfusion performances for periods of several hours. Of the perfusates devised and tested, a 1.75% solution of Haemaccel most fully satisfied the above criteria and maintained myocardial function for 30.0 ± 4.0 hr.     

一种猪模型的体外肺灌注系统的建立

目的:体外肺灌注技术(Ex vivo lung perfusion, EVLP)对于肺移植的实施意义重大,但成本昂贵。本文采用国产经济材料建立猪模型的EVLP系统,以探索保证系统性能的同时降低移植费用。方法:我们首先依据国产材料配置肺灌注液,并组装管道、连接仪器以建立EVLP系统;之后通过外科手段获得3头家猪的肺脏,并灌注肺灌注液,低温保存6小时;最后我们将肺脏连接到EVLP系统,通过血气分析和肺功能检查来评估肺脏随时间变化的状况。结果:离体并在低温保存6小时的猪肺脏,通过我们建立的相对经济的EVLP系统,可以在2小时内维持良好的氧合功能和肺生理指标:肺动脉压、气道峰压、平台压力、肺动脉氧气分压和二氧化碳分压和左心房的氧气分压和二氧化碳分压都保持稳定,同时肺脏具有正常的颜色和弹性,没有明显水肿和功能损害。结论:我们建立的EVLP系统可以有效地维护离体猪肺的生理功能,且降低了成本,从而为肺移植体外肺灌注技术的优化应用提供了研究基础。     

Characterisation and validation of a new murine model of global ischaemia-reperfusion injury

A specially designed Langendorff apparatus was constructed to allow perfusion of the isolated mouse heart. Hearts were randomised into groups to receive differing periods of global (zero flow) ischaemia or continuous perfusion (controls). During reperfusion, recovery of baseline force was recorded and perfusate collected for LDH assay (U/L/g wet weight). After 30 min reperfusion, hearts were stained with tetrazolium and planimetry performed to measure infarct size. Dose-response relationships were demonstrated for all 3 end-points against duration of ischaemic insult. Functional recovery and enzyme leakage correlated well with infarct size (r = 0.77, p < 0.001 and r = 0.73, p < 0.001 respectively). Transgenic mice may now be used to study the effect of specific phenotypic changes on the pathogenesis of ischaemia-reperfusion injury using a reliable and reproducible technique.     

Cardiac anaphylaxis in isolated guinea pig hearts perfused at constant flow or constant pressure

Acute responses to antigen-antibody interactions (anaphylactic reactions) in isolated guinea pig hearts are reported to include decreases in coronary flow, increases in heart rate, prolongation of impulse propagation, development of arrhythmias, and transient increases followed by substantial decreases in ventricular contractile force. It is not clear from these studies, however, whether all of the changes are direct effects of the mediators released by the antigen-antibody reaction or whether some of them are indirect results of the severe reduction in flow evoked by coronary vasoconstriction. Therefore, the present study was designed to assess cardiac anaphylactic events in isolated hearts of guinea pigs passively sensitized with IgG antibody to ovalbumin under conditions in which coronary perfusion pressure was maintained constant and to compare the responses to those of hearts in which coronary flow was maintained at a constant rate. Our data indicate that when coronary flow decreased during anaphylaxis (constant pressure perfusion), hearts responded to antigen challenge with greater prolongation of the PR interval, duration of arrhythmias, suppression of left ventricular systolic pressure, and release of histamine and adenosine plus inosine into the venous effluent than when coronary flow was maintained during anaphylaxis (constant flow perfusion). The data suggest that maintenance of coronary flow during cardiac anaphylaxis may attenuate the severity of the functional derangement.     

Myocardial perfusion in experimentally induced diabetes mellitus

Diabetes mellitus was induced in rabbits by alloxan monohydrate. At the end of six-week period, animals of the control and diabetic groups (8 rabbits each) were sacrificed and their hearts were excised and perfused using Langendorff apparatus. Results revealed that diabetes had adverse effects on myocardial perfusion. The baseline coronary flow and maximum coronary flow were significantly reduced in diabetic hearts as compared with those of the control. The maximum total coronary flow tended to decrease in the diabetic hearts. Products of the metabolic changes which accompanied diabetes might have directly and/or indirectly caused the observed reduction in the coronary vascular capacity of the diabetic heart.     

Cardiac dynamics of the Langendorff perfused heart

The Langendorff perfused heart is studied in a closed system with (i) automatic regulations to maintain constancy of the perfusion column (Krebs-Henseleit + 0.5% albumin or 25-30% washed erythrocyte suspension), (ii) continuous recording of rate, coronary flow, and supravalvular aortic pressure. A microcomputer with software interface is used for storage treatment and on-line analysis of the recorded variables. In 38 preparations perfused with Krebs-Henseleit, minimal diastolic (61.2 +/- 2.8 mm Hg) is significantly below and peak systolic (98.7 +/- 3.6 mm Hg) significantly above perfusion pressure (80 mm Hg). Pressure difference between minimal diastolic and peak systolic (delta P) is 37.5 +/- 1.8 mm Hg. Increases in perfusion pressure will be associated with increases of coronary flow and delta P, which is also increased by isoprenaline administration. Oxygen consumption decreased by 76% when perfusion pressure was lowered from 80 to 60 mm Hg in hearts perfused with a 30% erythrocyte suspension. All of these experimental results were interpreted as indicating that delta P measured in this system resulted from an ejected volume (x acceleration) from the heart. The ejected volume corresponds to a valvular leak caused by the rigid nature of the system which is devoid of aortic compliance. delta P may be considered an index of left ventricular performance, an indication that the Langendorff preparation studied under the present conditions is a working heart. A 100-microliter volume constant infusion syringe for time administration of cardioactive drugs may be inserted at the base of the perfusion column to obtain dose-response effects.     

An improved apparatus for blood perfusion of the canine cerebral vasculature

An improved perfusion apparatus is described which consists of a membrane oxygenator, roller pump, reservoir, heat exchanger, blood filter, and inert tubing. Heparinized blood may be used and is delivered at flow rates from 10 to 250 ml/min. Dogs are anesthetized with halothane and their cerebral arterial blood supply isolated by the method of Gilboe et al. (8). When the canine brain is perfused for 5 hr using the described apparatus, the rates of cerebral oxygen and glucose consumption are 5.19±0.12 ml/100 g/min and 39.9±6.5 mol/100 g/min, respectively. Of the total glucose consumed by the brain, about 1/4 is contributed by the erythrocytes. An equivalent of about 9% of the consumed glucose is returned to the blood as lactate. Electron microscopic examination of cerebral cortex samples reveals no differences between 5-hr perfused brain and appropriate nonperfused controls. It is concluded that the apparatus is a useful system for organ perfusion and that the canine brain perfused by this method remains physiologically and metabolically active for at least 5 hr.With the technical assistance of Evelyn Townsend.     

A TWO LITRE SCALE CONTINUOUS CULTURE APPARATUS FOR MICRO-ORGANISMS

SUMMARY: The design and construction of a continuous culture apparatus with a 2 1. culture vessel are described. Aeration is achieved by means of a mechanical stirrer and injected air, automatic temperature and pH control are features of the apparatus, and foaming is controlled by adding antifoam through a manually operated valve. A high degree of agitation ensures that good mixing takes place. Accurate and easily variable control of the medium flow rate is obtained by means of the Mariotte bottle principle. The apparatus can be operated continuously with freedom from contamination for periods in excess of 1000 hr.     

Ten-hour preservation of guinea pig isolated hearts perfused at low flow with air-saturated Lifor solution at 26{degrees}C: comparison to ViaSpan solution

There is no suitable solution to preserve hearts for longer than 5 h between donor explant and recipient implant. Lifor is a fully artificial preservation medium containing both a nonprotein oxygen and nutrient carrier (nanoparticles) and cellular nutrients, including amino acids and sugars. We proposed that recirculated Lifor solution would satisfactorily preserve guinea pig isolated hearts perfused at low flow with no added O(2) at room temperature for 10 h. Hearts were isolated from 21 guinea pigs and perfused with Krebs-Ringer (KR) solution (97% O(2) and 3% CO(2)) at 37 degrees C. Heart rate, inflow and outflow O(2) tension, coronary flow, left ventricular pressure (LVP), and maximal and minimal rate of change in LVP (dLVP/dt) were measured. After baseline measurements, hearts were perfused with recirculated Lifor or ViaSpan equilibrated with room air at 15% of control flow at 26 degrees C for 10 h. Hearts were then perfused at 100% flow with KR for 2 h at 37 degrees C. A time control (untreated) group was perfused only with KR solution for 15 h. Lifor arrested and protected hearts against diastolic contracture and maintained a low O(2) extraction. Compared with time controls, Lifor led to a higher developed LVP and coronary flow; %O(2) extraction and cardiac efficiency were similar between these two groups. Hearts similarly treated with ViaSpan exhibited diastolic contracture and lower %O(2) extraction during treatment and, upon reperfusion with KR, exhibited continued diastolic contracture, no return of heart rate or contractility, low coronary flow, low %O(2) extraction, and marked infarction. For long-term cardiac protection, a suitable preservation solution recirculated at low flow and room temperature without supplemental O(2) would reduce the support apparatus required for transport. Lifor was far superior to ViaSpan in meeting these requirements.