title: Effect of preprocurement ventilation on lungs donated after cardiac death in a canine lung transplantation model.
abstract: BACKGROUND
  One method of countering chronic lung donor shortages is the practice of donation after cardiac death (DCD). However, this technique inevitably leads to pulmonary dysfunction related to warm ischemia. One promising method of alleviating this problem is ventilation. However, it can rarely be initiated from the onset of cardiac arrest, particularly in uncontrolled DCD donors. We investigated the protective effect of the last 60 min of ventilation during a 240-min warm ischemic time.
  
  
  METHODS
  We rendered donor dogs cardiac dead and left them at room temperature. Six dogs received ventilation with 100% oxygen for 60 min starting at 180 min after cardiac arrest (ventilation group). Eight dogs received no ventilation. Lungs were harvested 240 min after cardiac arrest, then transplanted into recipient dogs. At 60 min after reperfusion, the right pulmonary artery was ligated, and the function of the left transplanted lung was evaluated.
  
  
  RESULTS
  In the ventilation group, all six animals survived for 240 min after reperfusion, whereas in the nonventilation group, only four of eight survived. The ventilation group demonstrated significantly better pulmonary oxygenation, shunt fraction, and wet-to-dry weight ratio. Furthermore, the ventilation group revealed significantly higher levels of high-energy phosphates in the lung tissues, fewer apoptotic cells, lower levels of tumor necrosis factor-α and interleukin-8 messenger RNA in the lung tissues, and lower levels of interleukin-6 messenger RNA in the serum.
  
  
  CONCLUSIONS
  Our results suggest that ventilation during the late phase of the preprocurement period may ameliorate ischemia-reperfusion injury in DCD donors.
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Sakamoto
authors.forename: Fengshi
authors.initials: F
authors.lastname: Chen
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yamada
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakajima
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ohsumi
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Kikuchi
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Zhao
authors.forename: Takuji
authors.initials: T
authors.lastname: Fujinaga
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shoji
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sakai
authors.forename: Toru
authors.initials: T
authors.lastname: Bando
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis; D000818:Animals; D017209:Apoptosis; D016207:Cytokines / Q000097:blood; D004285:Dogs; D008168:Lung / Q000473:pathology / Q000502:physiology; D016040:Lung Transplantation; D023421:Models, Animal; D009926:Organ Preservation / Q000379:methods*; D009929:Organ Size; D012121:Respiration, Artificial; D014019:Tissue Donors
chemical_list: D016207:Cytokines; D000255:Adenosine Triphosphate