title: Retrograde flush is more protective than heparin in the uncontrolled donation after circulatory death lung donor.
abstract: BACKGROUND
  Formation of microthrombi after circulatory arrest is a concern for the development of reperfusion injury in lung recipients from donation after circulatory death (DCD) donors. In this isolated lung reperfusion study, we compared the effect of postmortem heparinization with preharvest retrograde pulmonary flush or both.
  
  
  METHODS
  Domestic pigs (n = 6/group) were sacrificed by ventricular fibrillation and left at room temperature for 1 h. This was followed by 2.5 h of topical cooling. In control group [C], no heparin and no pulmonary flush were administered. In group [R], lungs were flushed with Perfadex in a retrograde way before explantation. In group [H], heparin (300 IU/kg) was administered 10 min after cardiac arrest followed by closed chest massage for 2 min. In the combined group, animals were heparinized and the lungs were explanted after retrograde flush [HR]. The left lung was assessed for 60 min in an ex vivo reperfusion model.
  
  
  RESULTS
  Pulmonary vascular resistance at 50 and 55 min was significantly lower in [R] and [HR] groups compared with [C] and [H] groups (P < 0.01 and P < 0.001) and at 60 min in [R], [H], and [HR] groups compared with [C] group (P < 0.001). Oxygenation, compliance, and plateau airway pressure were more stable in [R] and [HR] groups. Plateau airway pressure was significantly lower in [R] group compared with the [H] group at 60 min (P < 0.05). No significant differences in wet-dry weight ratio were observed between the groups.
  
  
  CONCLUSIONS
  This study suggests that preharvest retrograde flush is more protective than postmortem heparinization to prevent reperfusion injury in lungs recovered from donation after circulatory death donors.
authors.affiliation: Laboratory for Experimental Thoracic Surgery, Department of Thoracic Surgery, KU Leuven, Leuven, Belgium.
authors.forename: Caroline
authors.initials: C
authors.lastname: Van De Wauwer
authors.affiliation: Laboratory for Experimental Thoracic Surgery, Department of Thoracic Surgery, KU Leuven, Leuven, Belgium.
authors.forename: Arne P
authors.initials: AP
authors.lastname: Neyrinck
authors.affiliation: Laboratory for Experimental Thoracic Surgery, Department of Thoracic Surgery, KU Leuven, Leuven, Belgium.
authors.forename: Filip R
authors.initials: FR
authors.lastname: Rega
authors.affiliation: Department of Morphology and Molecular Pathology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Erik
authors.initials: E
authors.lastname: Verbeken
authors.affiliation: Laboratory for Experimental Thoracic Surgery, Department of Thoracic Surgery, KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium. Electronic address: dirk.vanraemdonck@uzleuven.be.
authors.forename: Dirk E M
authors.initials: DE
authors.lastname: Van Raemdonck
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000494:pharmacology; D002951:Citrates / Q000494:pharmacology*; D003080:Cold Temperature; D004195:Disease Models, Animal; D006085:Graft Survival / Q000187:drug effects; D006493:Heparin / Q000494:pharmacology*; D016040:Lung Transplantation / Q000379:methods*; D019188:Organ Preservation Solutions / Q000494:pharmacology; D009929:Organ Size; D015427:Reperfusion Injury / Q000517:prevention & control*; D034421:Sus scrofa; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014655:Vascular Resistance / Q000187:drug effects; D014693:Ventricular Fibrillation / Q000401:mortality*
chemical_list: D000925:Anticoagulants; D002951:Citrates; D019188:Organ Preservation Solutions; C070005:Perfadex; D006493:Heparin
keywords: Donation after circulatory death; Heparin; Retrograde flush; Topical cooling; Uncontrolled