Lung Retrieval from Non-Heart-Beating Donors: First Experience with an Innovative Preservation Strategy in a Pig Lung Transplantation Model

Abstract

Objective: Lung transplantation is limited by the scarcity of donor organs. Lung retrieval from non-heart-beating donors (NHBD) might extend the donor pool and has been reported recently. However, no studies in NHBD exist using the novel approach of retrograde preservation with Perfadex solution. Methods: Heparinized asystolic pigs (n = 5, 30–35 kg) were ventilated for 90 min. The lungs were retrogradely preserved with Perfadex solution and stored inflated at 4°C for 3 h. Left lung transplantation in the recipient was followed by exclusion of the right lung. Results were compared to sham-operated animals. Oxygenation, hemodynamics and dynamic compliance were monitored for 4 h. Infiltration of polymorphonuclear cells (PMNs) and stereological quantification of alveolar edema was performed. Statistical analysis comprised Kruskal-Wallis and Mann-Whitney tests and ANOVA analysis with repeated measures. Results: No mortality was observed. During preservation, continuous elimination of blood clots via the pulmonary artery venting site was observed. Oxygenation and compliance were similar between groups, but sham controls showed significantly lower pulmonary vascular resistance. Stereological quantification revealed higher volume fractions of intra-alveolar edema in NHBD grafts, while PMN infiltration was comparable to sham controls. Conclusions: Use of NHBD lungs results in excellent outcome after 90 min of warm ischemia followed by retrograde preservation with Perfadex solution. This novel approach can optimize lung preservation by eliminating clots from the pulmonary circulation and might clinically be considered in brain-dead organ donors who become hemodynamically unstable prior to organ harvest. Further trials with longer warm and cold ischemic periods are necessary to further elucidate this promising approach to donor pool expansion.

Outcomes of Pancreas Transplantation in the United States Using Cardiac-Death Donors

“…Organs from DCD donors might be also useful for islet, heart and lung transplantation (24,(30)(31)(32). Our data showed that the typical characteristics of DCD donors for pancreas transplantation (e.g.…”

Retrograde Flush Following Warm Ischemia in the Non-Heart-Beating Donor Results in Superior Graft Performance at Reperfusion

“…Compliance and oxygenation were similar in both groups, but pulmonary vascular resistance was significantly lower in the sham controls. They concluded that NHBD may benefit from a RF by elimination of thrombi from the pulmonary circulation, even in heparinized condition [29]. In another study, the same group compared RF in NHBD lungs of variable warm ischemic intervals with lungs obtained after standard preservation procedures (RF) using HBD and sham controls.…”

Experimental Lung Transplantation: Impact of Preservation Solution and Route of Delivery

“…With retrograde instillation, residual blood and macroscopic clots and other tissue emboli obstructing the pulmonary vessels can easily be washed out, and the distal vascular bed reached by the perfusate with an even dispersion. 30,31 Aside from studies dealing with only one of both modern preservation solutions, Celsior and Perfadex, there is a lack of large-animal studies with extended cold ischemia times that provide a direct comparison of the efficacy of both solutions with specific regard to route of delivery. Based on earlier excellent results with both solutions in our established small-animal screening model, 11,12,32 our experiments were thus undertaken to evaluate the impact of retrograde vs antegrade application of both low-potassium solutions using extended ischemic periods of 27 hours in an in vivo pig lung transplantation model.…”