title: Initial topical cooling followed by backtable Celsior flush perfusion provides excellent early graft function in porcine single lung transplantation after 24 hours of cold ischemia.
abstract: BACKGROUND
  Topical in situ cooling of the donor lungs is a prerequisite for procurement of non-heart-beating donor lungs and may be of interest for living related lung donation.
  
  
  METHODS
  Twenty-four single lung transplants were performed in 4 groups of Landrace pigs (6 per group). Control LPD, control Celsior and topical cooling in situ, followed by LPD (exLPD) or Celsior (exCel) ex situ flush, were employed. All lungs were perfused antegrade with 1 liter of solution at 4°C. Lungs were stored immersed in preservation solution for 24 hours at 4°C. After transplantation of the left lung, the right recipient bronchus and pulmonary artery were clamped.
  
  
  RESULTS
  Four of 6 animals each in the LPD and Celsior groups and all 6 animals in both the exLPD and the exCel groups survived the 7-hour reperfusion. The mean oxygenation index was favorably preserved in the exCel group at 7 hours after reperfusion (417 ± 81) over all other groups (LPD 341 ± 133, Celsior 387 ± 86, exLPD 327 ± 76; p < 0.0001). Pulmonary vascular resistance showed significantly lower values in the Celsior and exCel groups (LPD 1,310 ± 620, Celsior 584 ± 194, exLPD 1,035 ± 361, exCel 650 ± 116 dyn/s/cm(5) at 7 hours after reperfusion; p < 0.0001). Consistently, the wet-to-dry lung weight ratio also indicated beneficial graft protection in the exCel group (LPD 8.1 ± 0.8, Celsior 8.4 ± 0.8, exLPD 7.5 ± 1.0, exCel 3.1 ± 0.9; p < 0.0001).
  
  
  CONCLUSIONS
  Initial topical cooling followed by backtable perfusion is a sufficient technique for pulmonary graft preservation providing excellent post-transplant function. Celsior subsequent to in-situ topical cooling revealed the most beneficial results in this setting. This combined technique could advance non-heart-beating, living related lung lobe donation and, potentially, regular heart-beating lung donation.
authors.affiliation: Hannover Thoracic Transplant Program, Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gohrbandt
authors.forename: Murat
authors.initials: M
authors.lastname: Avsar
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
authors.forename: Sebastian-Patrick
authors.initials: SP
authors.lastname: Sommer
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Martin
authors.initials: M
authors.lastname: Strueber
mesh_terms: D000818:Animals; D050377:Cold Ischemia; D004187:Disaccharides; D004573:Electrolytes; D005260:Female; D005971:Glutamates; D005978:Glutathione; D006639:Histidine; D016040:Lung Transplantation; D008353:Mannitol; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion; D013552:Swine; D013997:Time Factors
chemical_list: C088453:Celsior; D004187:Disaccharides; D004573:Electrolytes; D005971:Glutamates; D008353:Mannitol; D006639:Histidine; D005978:Glutathione
keywords: Celsior; graft function; low potassium dextran (LPD); lung preservation; preclinical lung transplantation