Thoracic transplantation
Primary Graft Failure and Ca2+ Sensitizers After Heart Transplantation

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Abstract

Primary organ failure after heart transplantation is a severe complication generally related to prolonged ischemia time, poor quality of the organ, or rejection. Ca2+ sensitisers increase cardiac contractility without altering intracellular Ca2+ levels. Our aim was to evaluate the influence of levosimendan in the therapy of primary failure after heart transplantation. Five patients presenting with reduced ejection fraction (EF<30%) and high dosed catecholamines after heart transplantation were treated with levosimendan (Simdax, Abbot GesmbH, Vienna, Austria) in a 24-hour continuous infusion (0.10 μg/kg*min) postoperatively. We assessed hemodynamic measurements including MAP, CVP, and PAP as well as heart function. Pharmacologic support with catecholamines could be halved at 24 hours and terminated in four of the patients 72 hours after levosimendan administration. Hemodynamics (MAP 70 ± 11 vs 85 ± 6 mm Hg; CI 2.5 ± 0.4 vs 3.6 ± 0.4 L/min/m2) and EF (28 ± 10 vs 54 ± 4%) improved at 48 hours after treatment. Acute graft failure after cardiac transplantation is associated with poor short- and long-term outcomes. Among our patients, levosimendan reduced the need for catecholamine support as well as improved ventricular performance.

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Patients and Methods

Patients (n = 5) undergoing orthotopic heart transplantation and presenting postoperatively with high-dosed catecholamines (>2 mg/h of norepinephrine/epinephrine/milrinone) and reduced ejection fraction (EF<30%) were treated with levosimendan (Simdax, Abbot GesmbH, Vienna, Austria).

The EF was measured first by visual estimation and then using the modified biplane Simpson's method by two different observers. Levosimendan was administered intravenously in a 24-hour continuous infusion (0.10

Results

All patients showed similar demographic data; 80% were men and the overall mean age was 52 years. Dilated cardiomyopathy was the indication in 80% of cases. The average ischemia time of the hearts was 252 ± 28 minutes. The mean donor age was 33 years. Organ preservation was achieved in all cases with UW solution.

The hemodynamic measurements initially showed a MAP of 70 ± 11 mm Hg, a CVP of 17 ± 1.6 mm Hg, a MPAP of 28 ± 3 mm Hg, and a CI of 2.5 ± 0.4 L/min per m2. Two days after treatment with

Discussion

Acute graft failure is a complication associated with poor outcomes after cardiac transplantation. Various pathways contribute to primary heart failure after transplantation, including myocardial stunning, prolonged cold ischemia, right heart failure, arrhythmias induced by reperfusion injury, or inadequate preservation.6 Donor–recipient-related factors, such as depressed cardiac function following brain death may induce primary graft dysfunction.7

Catecholamines as well as phosphodiesterase

References (10)

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A. Beiras-Fernandez and F.C. Weis contributed equally to this work.

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