Practical Aspects of Prostaglandin E1 before and after Solid Organ Transplantation

Prostaglandins and analogues for therapeutic use gained importance in the early eighties, when a substantial number of clinical studies about their therapeutical effects was published6, 12, 17, 22. Out of the huge family of prostanoids, prostaglandins E1 (PG E1) and I2 and their synthetical analogues are the most important substances in clinical practice in the field of solid organ transplantation. Organ procurement and organ preservation4, 5, 9, 15, 19 as well as treatment of primary graft failure8, 10 have been described as possible indications for PG E1. Vasodilating effects of prostaglandins are mediated by increasing cAMP levels in vascular smooth muscle cells. This mediation by cAMP is shared with beta-agonists and phosphodiesterase-inhibitors, but not with nitrates and nitric oxide3, 14, 21. Treatment of elevated pulmonary vascular resistance (PVR), which is frequently needed after heart transplantation (HTX), and in the pretransplant evaluation as well as bridging to transplan-tation1, 7, 20 has been the indication for PG E1 in our patient cohort.