Determinants and prognostic value of ischemic necrosis in early biopsies following heart transplant

To evaluate the impact of early ischemic necrosis (IN) on the early and lat e outcome of heart transplantation, we reviewed our Ii-year experience. Bet ween January 1988 and June 1999, 207 heart transplants were performed in 20 5 patients (174 male and 31 female). Criteria for donor and recipient selec tion, and protocols for postoperative immunosuppression and rejection monit oring have remained unchanged over this period. Three different cardioplegi c solutions were employed in graft preservation: St. Thomas Hospital soluti on in the earliest 31 cases (15%), University of Wisconsin solution in 96 c ases (46.4%), and Celsior solution in the last 80 cases (38.6%). All patien ts who underwent at least one endomyocardial biopsy (176 patients) were div ided into two groups according to the findings of IN within the early 3 pos toperative months (group A, 49 patients with IN: group B, 127 patients with out IN). The following variables were estimated in each group: donor and re cipient age, ischemic time, type of cardioplegia, late mortality for cardia c causes, incidence of grade >2 rejection within the first 6 postoperative months, late incidence of grade >2 rejection, late incidence of NYHA class >II. No significant difference was found in any parameter between the two g roups, except for the type of cardioplegic solution. A significantly higher incidence of ischemic necrosis in hearts preserved with St. Thomas solutio n was found (P < 0.001). Although pathology findings show that extracellula r solutions carried a higher risk of early IN, no associated significant im pairment in terms of late survival and event-free rate was observed in reci pients with early IN.