Pulmonary graft function after long-term preservation of non-heart-beating donor lungs.
BACKGROUND
Critical organ shortage in lung transplantation could be attenuated by the use of non-heart-beating donor (NHBD) lungs. In addition, prolonged ischemic tolerance of the organs would contribute to the alleviation of organ shortage. The aim of this study was to investigate pulmonary graft function of NHBD lungs after long-term hypothermic storage.


METHODS
Twelve native-bred pigs (bodyweight 20 to 30 kg) underwent left lung allotransplantation. In the heart-beating donor (HBD) group, lungs were harvested immediately after cardiac arrest. In the NHBD group, lungs were subjected to a warm ischemic period of 90 minutes before harvesting. After a total ischemic time of 19 hours, pulmonary grafts in both groups were reperfused and pulmonary graft function was assessed. All values were compared with a sham-operated control group.


RESULTS
Pulmonary graft function in the HBD group was excellent. In the NHBD group, pulmonary gas exchange was impaired, but still provided good graft function compared with the excellent graft function in the HBD group. Pulmonary vascular resistance was even lower in the NHBD group. In the NHBD group, calculated intrapulmonary shunt fraction (Qs/Qt) was significantly increased compared with the sham-group. Histologic alteration and wet-to-dry ratio did not differ significantly between the HBD and NHBD group.


CONCLUSIONS
We conclude that NHBD lungs (90 minutes of warm ischemic time) have the potential to alleviate organ shortage in lung transplantation even after an extended total ischemic time.
Loehe
F
F
Department of Surgery, Institute of Pathology, University of Munich, Germany. foehe@gch.med.uni-muenchen.de
Mueller
C
C
Annecke
T
T
Siebel
A
A
Bittmann
I
I
Messmer
K F
KF
Schildberg
F W
FW
D000818:Animals; D007511:Ischemia; D008168:Lung / Q000098:blood supply / Q000502:physiology*; D016040:Lung Transplantation; D009926:Organ Preservation / Q000379:methods*; D013552:Swine; D013997:Time Factors; D014184:Transplantation, Homologous; D014655:Vascular Resistance