Treatment of the brain-dead lung donor with aprotinin and nitric oxide.
BACKGROUND
It has been previously shown that donor treatment with aprotinin or inhaled nitric oxide reduces reperfusion injury after lung transplantation in animals. These studies used living donors with normal lungs. However, the main source of lungs for transplantation is brain-dead donors. Brain death causes systemic inflammatory response and lung injury, rendering the organ susceptible to reperfusion injury after transplantation. We hypothesized that treatment with aprotinin or inhaled nitric oxide after brain death would improve the donor inflammatory response and reduce lung reperfusion injury after transplantation.


METHODS
Brain death was induced in 24 rats by intracranial balloon inflation. Subsequently, the animals received intravenous aprotinin (n = 8), inhaled nitric oxide (n = 7), or no treatment (n = 9) for 5 hours. The lungs were retrieved and reperfused for 2 hours using recipient rats.


RESULTS
After brain death, oxygenation deteriorated earlier and significantly more in rats that received treatment, especially with nitric oxide. Treatment did not reduce the donor systemic inflammatory response as assessed by serum levels of proinflammatory cytokines. Oxygenation, airway pressure, pulmonary vascular resistance, lung water index and bronchoalveolar lavage cytokine levels were similar after reperfusion of grafts from all three groups of donors.


CONCLUSIONS
Donor treatment with aprotinin or inhaled nitric oxide does not improve lungs that have been injured by brain death.
Avlonitis
Vassilios S
VS
Applied Immunology and Transplant Research Group, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom. avlonitis@hotmail.com
Wigfield
Christopher H
CH
Kirby
John A
JA
Dark
John H
JH
D000818:Animals; D007611:Aprotinin / Q000008:administration & dosage*; D001926:Brain Death; D055370:Lung Injury / Q000517:prevention & control*; D016040:Lung Transplantation; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D051381:Rats; D017208:Rats, Wistar; D015427:Reperfusion Injury / Q000517:prevention & control*; D014019:Tissue Donors; D016896:Treatment Outcome
D009569:Nitric Oxide; D007611:Aprotinin