The aim of the study is to investigate the effects of donor simvastatin treatment on ischemia-reperfusion injury after heart transplantation.
The study hypothesis of the single center randomized double-blinded clinical trial is that donor simvastatin treatment reduces ischemia-reperfusion injury after heart transplantation. Also, it potentially decreases natural immune activity, rejection activation and thus improves long-term prognosis. Simvastatin is administered to heart and/or lung donors through the nasogastric tube 4-6 hours prior to organ harvesting. Control organ donors do not receive simvastatin. The randomization and donor hospital instruction of the donor simvastatin treatment is performed by the transplant coordinator. All other caregivers and the transplant recipient are blinded to the treatment group allocation. The impact of donor simvastatin treatment is investigated and analyzed by several specific blood samples and biopsies that are taken from the recipient at the various time-points during the perioperative and postoperative phase. In heart transplant recipients (n=42 in the donor simvastatin treatment group and n=42 in the control group), the primary end-point is postoperative cardiac enzyme serum levels (TnT, TnI, and CK-MB 1 hour, 6 hours, 12 hours and 24 hours after transplantation) and primary graft failure. Secondary end-points include peri- and postoperative parameters hemodynamics, short- and long term survival, biopsy-proven rejections, rejection treatments, and chronic rejection at 1, 5, 10, and 20 years after transplantation. Lung, kidney and liver transplant recipients that have received organs from donors randomized to the control group or donor simvastatin group will also be followed for ischemia-reperfusion injury, perioperative organ function, innate and adaptive immunity and patient survival.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
84
The transplant recipients who have received an organ from donors treated with simvastatin 80 mg.
The transplant recipients who have received an organ from non-treated donors.
Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital
Helsinki, Finland
Donor treatment with simvastatin reduces ischemia-reperfusion injury after heart transplantation
Recipient plasma release of cardiac troponins and creatinine kinase-MB and P-lactate, S-hs-CRP, peripheral blood leukocytes and neutrophils after heart transplantation
Time frame: 1-24 hour
Postoperative hemodynamics
Arterial line and pulmonary artery catheter measurements 6, 12, 24, 48, and 72 hours
Time frame: 0-72h
Postoperative use of inotropes and hemodynamic support
Postoperative use of inotropes and hemodynamic support at 6, 12, 24, 48, and 72 hours and the length of inotropic support
Time frame: 0-72h
Heart transplant function
Heart transplant function analyzed by P-ProBNP and echocardiogram
Time frame: 0-20 years
Cardiac allograft vasculopathy
Cardiac allograft vasculopathy analyzed coronary angiogram
Time frame: at 1, 3, and 5 years
Biopsy proven acute rejection
Grade of rejection at endomyocardial biopsy
Time frame: 0-20 years
Rejection treatments
Any rejection treatments
Time frame: 0-20 years
Short- and long-term survival
Time to all-cause mortality
Time frame: 0-20 years
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Substudy 1
Outcome of kidney transplant recipients
Time frame: 0-20 years
Substudy 2
Outcome of liver transplant recipients
Time frame: 0-20 years
Substudy 3
Outcome of lung transplant recipients
Time frame: 0-20 years
Substudy 4
Development of biomarkers for ischemia-reperfusion injury after heart transplantation
Time frame: 0-24 h
Substudy 5
Development of molecular profiling for endomyocardial biopsy after heart transplantation
Time frame: 0-1 years
Substudy 6
Effect of donor and recipient genomic backgroud on long term outcomes after heart transplantation
Time frame: 0-20 years
Substudy 7
Effect of donor and recipient genomic backgroud on long term outcomes after kidney transplantation
Time frame: 0-20 years