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Eur J Cardiothorac Surg 2006;30:621-627
© 2006 Elsevier Science NL

The role of leukocyte depleting filters in heart transplantation: early outcomes in prospective, randomized clinical trial

^a Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
^b Department of Clinical Biochemistry, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Received 10 April 2006; received in revised form 20 July 2006; accepted 25 July 2006.

^_* Corresponding author. Address: Budovatelu 2620, Tabor 39002, Czech Republic. Tel.: +420 608442280; fax: +420 261362776. (Email: lubos.dvorak{at}seznam.cz).

Objective: Leukocyte-mediated reperfusion injury to cardiac allograft in the perioperative period is most likely associated with the early and late mortality after heart transplantation (Htx). Our aim is to determine the efficacy and safety of using leukocyte-depleting filters in a cardiopulmonary bypass (CPB) and secondary blood cardioplegia (SBC) circuit in Htx. Methods: A prospective, randomized trial was performed in 40 patients undergoing orthotopic Htx. These patients were divided into two groups, to be treated with either leukocyte-depleted (LD) reperfusion (n = 20) in the LD group, or whole blood reperfusion (n = 20) in the Control group. The SBC was used in both groups. Results: Intraoperatively, the LD group presented the reduced markers of reperfusion injury. The course of the creatine kinase MB (CK-MB) releases was significantly lower in the LD group (p < 0.05). The LD hearts showed better spontaneous rhythm resumption (60% vs 10%; p < 0.001), and lower need for isoprenaline (0.02 ± 0.01 µg/(kg min) vs 0.03 ± 0.02 µg/(kg min); p < 0.05) and epicardial pacing (25% vs 60%; p < 0.05) for weaning off CPB. Postoperatively, lower and shorter need for inotropic support (48 ± 46, median = 35 h vs 131 ± 68, median = 109 h; p < 0.001), shorter temporary epicardial pacing (6 ± 14, median = 0 h vs 25 ± 52, median = 1 h; p < 0.01), and lower 24-h chest drainage (551 ± 274, median = 500 ml vs 973 ± 836, median = 665 ml; p < 0.05) in the LD group contributed to the shorter mechanical ventilation time (8 ± 3, median = 7.5 h vs 14 ± 12, median = 8.5 h; p < 0.05) and the shorter stay at an intensive care unit (ICU) (70 ± 24 h vs 116 ± 73 h; p < 0.05). The 30-day mortality was zero in both groups. Conclusions: The use of leukocyte depleting filters in heart transplantation is an effective, easy and safe method of myocardial protection, reducing significant myocardial reperfusion injury and improving posttransplant graft functional recovery.

Key Words: Heart transplantation • Leukocyte depletion • Blood cardioplegia • Reperfusion injury