Reconditioning lungs donated after cardiac death using short-term hypothermic machine perfusion.
BACKGROUND
Hypothermic machine perfusion (HMP) is widely used to preserve kidneys and livers for transplantation. This study investigated whether short-term HMP could improve the quality of lungs donated after cardiac death (DCD).


METHODS
In a clinically relevant uncontrolled DCD model, beagles were divided into two groups (n=5 each): 4 hr warm ischemia + 14 hr static cold storage (SCS group) or 4 hr warm ischemia + 12 hr SCS followed by 2 hr HMP (HMP group). HMP was performed using centrifugal perfusion with STEEN solution at approximately 10°C. In both groups, the left lungs were then transplanted and reperfused for 4 hr to evaluate the posttransplantation lung functions.


RESULTS
HMP was performed safely, not inducing any oxidative damage. The dynamic pulmonary compliance was stable during HMP, whereas the pulmonary vascular resistance significantly decreased. HMP microscopically eliminated residual microthrombi in the donor lungs just before transplantation. The lung tissue adenosine triphosphate levels 4 hr after reperfusion were significantly higher in the HMP group compared with the SCS group. The serum malondialdehyde levels and proinflammatory cytokine levels in the bronchoalveolar lavage fluid 4 hr after reperfusion were significantly lower in the HMP group than in the SCS group. The physiologic lung functions during reperfusion were significantly better in the HMP group compared with the SCS group. HMP also significantly reduced ischemia-reperfusion injury in the microscopic findings.


CONCLUSIONS
Short-term HMP could resuscitate ischemically damaged DCD lungs and ameliorate ischemia-reperfusion injury.
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan. daink@kuhp.kyoto-u.ac.jp
Daisuke
D
Nakajima
Fengshi
F
Chen
Kenji
K
Okita
Hideki
H
Motoyama
Kyoko
K
Hijiya
Akihiro
A
Ohsumi
Jin
J
Sakamoto
Tetsu
T
Yamada
Masaaki
M
Sato
Akihiro
A
Aoyama
Toru
T
Bando
Hiroshi
H
Date
D000255:Adenosine Triphosphate / Q000032:analysis; D000818:Animals; D016207:Cytokines / Q000032:analysis; D003643:Death; D004285:Dogs; D007036:Hypothermia, Induced / Q000295:instrumentation / Q000379:methods*; D015994:Incidence; D007260:Infusion Pumps; D008168:Lung / Q000737:chemistry / Q000502:physiology*; D016040:Lung Transplantation / Q000502:physiology*; D023421:Models, Animal; D009926:Organ Preservation / Q000295:instrumentation / Q000379:methods*; D015427:Reperfusion Injury / Q000517:prevention & control; D013927:Thrombosis / Q000453:epidemiology; D013997:Time Factors
D016207:Cytokines; D000255:Adenosine Triphosphate