title: Continuous infusion of nitroglycerin improves pulmonary graft function of non-heart-beating donor lungs.
abstract: BACKGROUND
  The warm ischemic period of lungs harvested from a non-heart-beating donor (NHBD) results in an increased ischemia-reperfusion injury after transplantation. The intravenous application of nitroglycerin (NTG), a nitric oxide (NO) donor, proved to be beneficial during reperfusion of lung grafts from heart-beating donors. The objective of the present study was to investigate the effect of nitroglycerin on ischemia-reperfusion injury after transplantation of long-term preserved NHBD-lungs.
  
  
  METHODS
  Sixteen pigs (body weight, 20-30 kg) underwent left lung transplantation. In the control group (n=5), lungs were flushed (Perfadex, 60 mL/kg) and harvested immediately after cardiac arrest. In the NHBD group (n=5) and the NHBD-NTG group (n=6), lungs were flushed 90 min (warm ischemia) after cardiac arrest. After a total ischemia time of 19 hr, lungs were reperfused and graft function was observed for 5 hr. Recipient animals in the NHBD-NTG group received 2 microg/kg/min of NTG administered intravenously during the observation period starting 5 min before reperfusion. Tissue specimens and bronchoalveolar lavage fluid (BALF) were obtained at the end of the observation period.
  
  
  RESULTS
  Compared with the control group, pulmonary gas exchange was significantly impaired in the NHBD group, whereas graft function in the NHBD-NTG group did not change. Leukocyte fraction and protein concentration in the BALF and histologic alteration of the NHBD-NTG group were not different from controls.
  
  
  CONCLUSIONS
  Continuous infusion of NTG in the early reperfusion period improves pulmonary graft function of NHBD lungs after long-term preservation. The administration of an NO donor during reperfusion may favor the use of NHBD lungs to alleviate the critical organ shortage in lung transplantation.
authors.affiliation: Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, D-81377 Munich, Germany. florian.loehe@gch.med.uni-muenchen.de
authors.forename: Florian
authors.initials: F
authors.lastname: Loehe
authors.forename: Gerhard
authors.initials: G
authors.lastname: Preissler
authors.forename: Thorsten
authors.initials: T
authors.lastname: Annecke
authors.forename: Iris
authors.initials: I
authors.lastname: Bittmann
authors.forename: Karl W
authors.initials: KW
authors.lastname: Jauch
authors.forename: Konrad
authors.initials: K
authors.lastname: Messmer
mesh_terms: D000818:Animals; D006323:Heart Arrest; D007262:Infusions, Intravenous; D008168:Lung / Q000648:ultrastructure; D016040:Lung Transplantation / Q000502:physiology*; D008855:Microscopy, Electron, Scanning; D023421:Models, Animal; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D009926:Organ Preservation / Q000379:methods; D015424:Reperfusion / Q000379:methods; D015427:Reperfusion Injury / Q000517:prevention & control*; D012129:Respiratory Function Tests; D013552:Swine; D014019:Tissue Donors
chemical_list: D005996:Nitroglycerin