EFFICACY ASSESSMENT OF CRYO STORAGE OF DONOR HEARTS BY IMAGEJ BASED IMAGE ANALYSIS

Aim. Donor organ injury during cold preservation before transplantation negatively impacts graft survival. The current study was to examine available evidences for the efficacy of different cold storage solutions that are used to preserve donor hearts in vitro prior to orthotopic transplantation.

Material and methods. A systematic search of full-length articles published from 1980 to August 2012 was performed in PubMed and Google Scholar. Detailed searches were also made for availability of any sourceware for histopathology images of endomyocardial biopsies of stored hearts.

Results. Not even a single controlled trial has been published relating to this topic. However, we assessed all available literature pertaining to this topic, and performed original, simple yet innovative analyses using ImageJ, a Java based image analyses program, to show the tremendous power to objectively examine the efficacy of the storage solution. Our analysis suggest that ImageJ may be conveniently used to obtain evidences (or lack of it) of ischemic injury of donor hearts during cold storage.

Conclusions. Even the UNOS database does not provide histopathological evidences of cardiac biopsies of orthotopically transplanted hearts. We, however, make the case of the need for image analyses and making availability of images to allow establishing evidence of the usefulness of these storage solutions. We recommend obtaining endomyocardial biopsy prior to orthotopic transplantation and create a registry of H&E stained slides. This is the only step that will direct us towards evidence based care of such highly critical patients who need the equally challenging surgical intervention of cardiac transplantation.

1. Yetgin T, Manintveld OC, Groen F, et al. The Emerging Application of Remote Ischemic Conditioning in the Clinical Arena. Cardiol Rev 2012; 20: 279–87.

2. Lima ML, Fiorelli AI, Vassallo DV, et al. Comparative experimental study of myocardial protection with crystalloid solutions for heart transplantation. Rev Bras Cir Cardiovasc 2012; 27: 110–6.

3. Poston RS, Gu J, Prastein D, et al. Optimizing donor heart outcome after prolonged storage with endothelial function analysis and continuous perfusion. Ann Thorac Surg 2004; 78: 1362–70.

4. George TJ, Arnaoutakis GJ, Beaty CA, et al. A novel method of measuring cardiac preservation injury demonstrates University of Wisconsin solution is associated with less ischemic necrosis than Celsior in early cardiac allograft biopsy specimens. J Heart Lung Transplant 2012; 31: 410–8.

5. Thatte HS, Rousou L, Hussaini BE, et al. Development and evaluation of a novel solution, Somah, for the procurement and preservation of beating and nonbeating donor hearts for transplantation. Circulation 2009; 120: 1704–13.

6. Dardas TF, Cowger J, Koelling TM, et al. The effectiveness of United Network of Organ Sharing status 2 transplantation in the modern era. J Heart Lung Transplant 2011; 30: 1169–74.

7. George TJ, Arnaoutakis GJ, Baumgartner WA, et al. Organ storage with University of Wisconsin solution is associated with improved outcomes after orthotopic heart transplantation. J Heart Lung Transplant 2011; 30: 1033–43.

8. Stringham JC, Love RB, Welter D, et al. Does University of Wisconsin solution harm the transplanted heart? J Heart Lung Transplant 1999; 18: 587–96.

9. Kajihara N, Morita S, Tanoue Y, et al. The UW solution has greater potential for longer preservation periods than the Celsior solution: comparative study for ventricular and coronary endothelial function after 24-h heart preservation. Eur J Cardiothorac Surg 2006; 29: 784–9.

10. Baxter K, Howden BO, Jablonski P. Heart preservation with celsior solution improved by the addition of nitroglycerine. Transplantation 2001; 71: 1380–4.

11. Collins T. J. ImageJ for microscopy. Biotechniques 2007; 43: 25–30.