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Ultrastructure changes associated with brain death in the human donor heart
D Novitzky1, J Rhodin, D K Cooper
1Department of Cardiothoracic Surgery, University of South Florida, Tampa 33612-4799, USA.
Summary
Donor heart biopsies showed similar ultrastructural injury before and after storage. Injury to sarcomeres and mitochondria was prevalent, with no increase seen in storage periods under 6 hours.
Area of Science:
- Cardiology
- Pathology
- Transplantation Medicine
Background:
- Donor heart quality is crucial for successful transplantation.
- Understanding myocardial injury during storage is vital for improving outcomes.
Purpose of the Study:
- To assess ultrastructural injury in human donor myocardial biopsies before and after storage.
- To determine the impact of ischemic storage time on myocardial integrity.
Main Methods:
- Electron microscopy was used to examine 30 myocardial biopsies from 22 human donor hearts.
- Biopsies were analyzed immediately after excision (prestorage) and before transplantation (poststorage).
- Eleven myocardial structures were scored for injury by two independent morphologists, achieving 84% interobserver correlation.
Main Results:
- Prestorage left ventricular biopsies (n=11) revealed 20-25% moderate to severe ultrastructural injury.
- Poststorage left ventricular biopsies (n=15) showed no significant difference in injury compared to prestorage.
- Sarcomere and mitochondrial injury were prominent, with no increased injury observed for storage < 6 hours.
Conclusions:
- Short-term ischemic storage (< 6 hours) does not exacerbate myocardial ultrastructural injury.
- Donor hearts requiring high inotropic support exhibited a higher incidence of moderate to severe injury.
- These findings suggest that donor factors may influence myocardial resilience during storage.