Lungs exposed to 1 hour warm ischemia without heparin before harvesting might be suitable candidates for transplantation.
BACKGROUND
The limiting factor for lung transplantation is the lack of donor organs. The usage of lungs from donation after cardiac death (DCD) would dramatically increase donor availability. In the present paper we wanted to investigate lungs exposed to 1 h of warm ischemia without heparin followed by flush-perfusion and cold storage compared to lungs harvested from heart beating donors (HBD) using standard harvesting technique.


METHODS
Twelve Swedish domestic pigs were randomized into two groups. Six pigs (DCD group) underwent ventricular fibrillation and were then left untouched for 1 h after declaration of death. They did not receive heparin. The lungs were then harvested and flush-perfused with Perfadex® solution and the organs were stored at 8 °C for 4 h. Six pigs (HBD group) received heparin and the lungs were harvested and flush-perfused with Perfadex® solution and the organs were stored at 8 °C for 4 h. Lung function was evaluated, using ex vivo lung perfusion (EVLP), with blood gases at different oxygen levels, pulmonary vascular resistance (PVR), lung weight, and macroscopic appearance.


RESULTS
At FiO2 1.0, the PaO2 in the DCD group was 51.7 ± 2.0 kPa and in the HBD group 68.6 ± 2.4 kPa (p < 0.01). Significantly lower PVR levels were measured in the DCD group (372 ± 31 dyne x s/cm(5)) compared to the HBD group (655 ± 45 dyne x s/cm(5)) (p < 0.001). There was no significant difference between groups in weight, compliance or signs of pulmonary thrombosis or embolization.


CONCLUSIONS
It seems as if DCD lungs exposed to 1 h of warm ischemia before 4 h of cold storage has satisfying oxygenation capacity, low PVR, normal weight and no signs of thrombosis or embolization. According to our study it seems as lungs exposed to 1 h warm ischemia without heparin might be good candidates for transplantation.
Department of Pediatric Anesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.
Annika
A
Liersch-Nordqvist
Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
Richard
R
Ingemansson
Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
Leif
L
Pierre
Department of Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
Joanna
J
Hlebowicz
Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden. sandra.lindstedt.ingemansson@gmail.com.
Sandra
S
Lindstedt
D000818:Animals; D002245:Carbon Dioxide / Q000097:blood; D002951:Citrates; D004195:Disease Models, Animal; D005260:Female; D006493:Heparin; D008168:Lung / Q000601:surgery; D016040:Lung Transplantation / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D010477:Perfusion / Q000379:methods; D034421:Sus scrofa; D014019:Tissue Donors; D014021:Tissue Preservation / Q000379:methods; D020858:Tissue and Organ Harvesting / Q000379:methods*; D009927:Tissue and Organ Procurement / Q000379:methods; D014655:Vascular Resistance; D052096:Warm Ischemia / Q000379:methods*
D002951:Citrates; C070005:Perfadex; D002245:Carbon Dioxide; D006493:Heparin; D010100:Oxygen