Post-mortem administration of urokinase in canine lung transplantation from non-heart-beating donors.
BACKGROUND
We previously reported that post-mortem heparinization by closed-chest cardiac massage within 30 minutes after cardiac arrest is beneficial in lung transplantation (LTx) from non-heart-beating donors (NHBDs) by preventing formation of microthrombi. In this study, we evaluated the effects of post-mortem administration of urokinase 60 minutes after cardiac arrest.


METHODS
Left LTx was performed in 12 pairs of mongrel dogs. Donors were sacrificed and left at room temperature for 2 hours. In Group 1 (n = 6), heparin sodium (1,000 U/kg) was administered intravenously 60 minutes after cardiac arrest, then closed-chest cardiac massage was performed for 1 minute to distribute the heparin. In Group 2 (n = 6), the donors were treated as in Group 1, except, in addition to heparin sodium, urokinase (120,000 U) was administered intravenously before and at the end of cardiac massage. After 2 hours of cardiac arrest, donor lungs were flushed with low-potassium dextran glucose solution. After left LTx, the right pulmonary artery was ligated, and recipients were followed up for 3 hours. Uni- and multivariate repeat analyses were performed to obtain statistical data.


RESULTS
Group 2 had significantly better arterial oxygen tension, lower pulmonary vascular resistance and lower wet/dry weight ratio of the transplanted lung than Group 1. d-dimer level during the warm ischemia was significantly lower in Group 2 than in Group 1.


CONCLUSIONS
Post-mortem administration of urokinase along with heparin is beneficial in LTx from NHBDs by fibrinolytic action on already formed pulmonary microthrombi in the cadaver donor lungs.
Sugimoto
Ryujiro
R
Department of Cancer and Thoracic Surgery, Surgery II, Okayama University Graduate School, Okayama, Japan.
Date
Hiroshi
H
Sugimoto
Seiichiro
S
Okazaki
Mikio
M
Aokage
Keiju
K
Inokawa
Hidetoshi
H
Aoe
Motoi
M
Sano
Yoshifumi
Y
D000818:Animals; D002102:Cadaver; D004285:Dogs; D005342:Fibrinolysis / Q000187:drug effects; D006323:Heart Arrest / Q000503:physiopathology*; D006336:Heart Massage; D006493:Heparin / Q000494:pharmacology; D007275:Injections, Intravenous; D008168:Lung / Q000187:drug effects / Q000502:physiology; D016040:Lung Transplantation / Q000379:methods* / Q000502:physiology*; D009926:Organ Preservation / Q000379:methods; D009929:Organ Size / Q000187:drug effects / Q000502:physiology; D011180:Postmortem Changes; D013927:Thrombosis / Q000517:prevention & control; D014019:Tissue Donors; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology*; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology
D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator