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

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 needfor isoprenaline (0.02 0.01 mg/(kg min)vs0.03 0.02 mg/(kg min);p < 0.05)andepicardialpacing(25%vs60%;p < 0.05) forweaningoff 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). The30-daymortalitywaszeroinbothgroups.Conclusions:Theuseofleukocytedepletingfiltersinhearttransplantationisan effective,easyand safe method of myocardial protection, reducing significant myocardial reperfusion injury and improving posttransplant graft functional recovery.