Lungs exposed to 1 hour warm ischemia without heparin before harvesting might be suitable candidates for transplantation

Journal of Cardiothoracic Surgery

Sandra Lindstedt²  Joanna Hlebowicz³  Leif Pierre²  Richard Ingemansson²  Annika Liersch-Nordqvist¹ 

[1] Department of Pediatric Anesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden;Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden;Department of Medicine, Skåne University Hospital, Lund University, Malmö, Sweden

关键词: Heart beating donor;    Experimental animal study;    Ex vivo lung perfusion;    Donation after cardiac death;    Lung transplantation;   

Others  :  1230549
DOI  :  10.1186/s13019-015-0339-1

 received in 2015-04-16, accepted in 2015-10-05,  发布年份 2015

【 摘 要 】

Background

The limiting factor for lung transplantation is the lack of donor organs. The usage of lungs from donation after cardiac death (DCD) would dramatically increase donor availability. In the present paper we wanted to investigate lungs exposed to 1 h of warm ischemia without heparin followed by flush-perfusion and cold storage compared to lungs harvested from heart beating donors (HBD) using standard harvesting technique.

Methods

Twelve Swedish domestic pigs were randomized into two groups. Six pigs (DCD group) underwent ventricular fibrillation and were then left untouched for 1 h after declaration of death. They did not receive heparin. The lungs were then harvested and flush-perfused with Perfadex® solution and the organs were stored at 8 °C for 4 h. Six pigs (HBD group) received heparin and the lungs were harvested and flush-perfused with Perfadex® solution and the organs were stored at 8 °C for 4 h. Lung function was evaluated, using ex vivo lung perfusion (EVLP), with blood gases at different oxygen levels, pulmonary vascular resistance (PVR), lung weight, and macroscopic appearance.

Results

At FiO ₂1.0, the PaO ₂in the DCD group was 51.7 ± 2.0 kPa and in the HBD group 68.6 ± 2.4 kPa (p < 0.01). Significantly lower PVR levels were measured in the DCD group (372 ± 31 dyne x s/cm ⁵ ) compared to the HBD group (655 ± 45 dyne x s/cm ⁵ ) (p < 0.001). There was no significant difference between groups in weight, compliance or signs of pulmonary thrombosis or embolization.

Conclusions

It seems as if DCD lungs exposed to 1 h of warm ischemia before 4 h of cold storage has satisfying oxygenation capacity, low PVR, normal weight and no signs of thrombosis or embolization. According to our study it seems as lungs exposed to 1 h warm ischemia without heparin might be good candidates for transplantation.

【 授权许可】

   
2015 Liersch-Nordqvist et al.

【 图 表 】

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