FUNCTIONAL RECOVERY AFTER HUMAN HEART-TRANSPLANTATION IS RELATED TO THE METABOLIC CONDITION OF THE HYPOTHERMIC DONOR HEART

Background Although strict selection criteria are being used for the a cceptance of human donor hearts for transplantation, problems with res pect to functional recovery on reperfusion sometimes still occur. Ther efore, evaluation of the viability of a human donor heart before impla ntation during heart transplantation may be of great value. Methods an d Results In the present study, the energy me tabolism of 25 excised h uman donor hearts arrested with St Thomas' Hospital No. 2 cardioplegic solution was evaluated noninvasively by use of P-31 magnetic resonanc e spectroscopy (MRS) before implantation and was correleted with myoca rdial function measured with thermodilution in heart transplant patien ts. No significant correlation was observed between the cardiac index of heart transplant patients during the first hours after transplantat ion and the phosphocreatine/ATP (r=.13, P=.54), inorganic phosphate/AT P (r=.26, P-.21), phosphomonoesters/ATP (r=.02, P=.92), or phosphocrea tine/inorganic phosphate (r=.16, P=.44) ratio or the intracellular pH (r=.06, P=.78) at the time of reperfusion. However, 1 week after trans plantation, a significant correlation was observed between the cardiac index and the phosphocreatine/ATP (r=.49, P=.01), phosphomonoesters/A TP (r=.45, P=.02), and phosphocreatine/inorganic phosphate (r=.40, P=. 05) ratios at the time of reperfusion. In contrast, the inorganic phos phate/ATP (r=.10, P=.63) ratio and pH (r=.31, P=.13) at the time of re perfusion showed a poor correlation with the cardiac index 1 week afte r transplantation. Conclusions Functional recovery after human heart t ransplantation is related to the metabolic condition of the hypothermi c donor heart.