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Eur J Cardiothorac Surg 2006;30:628-636
© 2006 Elsevier Science NL

Comparative study of donor lung injury in heart-beating versus non-heart-beating donors

^a Laboratory for Experimental Thoracic Surgery, Katholieke Universiteit Leuven, Belgium
^b Laboratory for Pneumology, Katholieke Universiteit Leuven, Belgium
^c Center for Experimental Anesthesiology, Emergency and Intensive Care Medicine, Katholieke Universiteit Leuven, Belgium
^d Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium

Received 4 October 2005; received in revised form 22 May 2006; accepted 12 June 2006.

^_* Corresponding author. Address: Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. Tel.: +32 16 34 68 23; fax: +32 16 34 68 24. (Email: dirk.vanraemdonck{at}uzleuven.be).

Objective: The use of non-heart-beating donors (NHBD) has been advocated as an alternative to overcome the critical organ shortage in lung transplantation despite the warm ischemic period that may result in primary graft dysfunction. On the contrary, brain death in the heart-beating donor (HBD) may be an underestimated risk factor for donor lung injury. We postulated that 60 min of warm ischemia in the NHBD is less detrimental to the lung than the pathophysiological changes after brain death in the HBD. In this study we compared the quality of lungs from HBD versus NHBD in an isolated reperfusion model. Methods: Pigs (n = 10 per group) were divided into three groups. In group I (HBD), brain death was induced by acute inflation of an intracranial epidural balloon catheter. In group II (CONTROL), the balloon was not inflated. In group III (NHBD), cardiac arrest was induced by myocardial fibrillation. After 5 h of in situ mechanical ventilation, lungs in HBD and CONTROL were preserved with a cold antegrade flush. In NHBD, unflushed grafts were explanted after 1 h of warm ischemia and 4 h of topical cooling in the cadaver. Graft performance was evaluated during 1 h in an isolated ventilation and reperfusion model. Extravascular lung water content (EVLW) was calculated. All data are reported as mean ± SEM. Results: A significant autonomic storm was observed in HBD following balloon inflation. During ex vivo assessment, pulmonary vascular resistance (PVR) at 60 min in HBD (2634 ± 371 dyne s cm^–5) was significantly higher as compared with that of CONTROL and NHBD (1894 ± 137 dynes s cm^–5 and 1268 ± 111 dynes s cm^–5, respectively; p < 0.05). Plateau airway pressure (Plateau AwP) was also higher in HBD (17 ± 1 cmH₂O) compared with that of CONTROL (12 ± 1 cmH₂O; p < 0.05) and NHBD (14 ± 1 cmH₂O; not significant). No significant differences were observed between HBD, CONTROL and NHBD in EVLW (79 ± 1%, 79 ± 0% and 78 ± 1%, respectively), and in PO₂/FiO₂ (564 ± 58 mmHg, 622 ± 14 mmHg and 578 ± 26 mmHg, respectively). Conclusions: These data indicate that 1-h warm ischemic lungs in our model are less susceptible to ischemia–reperfusion injury than lungs retrieved 5 h after brain death. This study further supports the use of lungs from NHBD for pulmonary transplantation.

Key Words: Lung transplantation • Non-heart-beating donor • Heart-beating donor • Brain death • Primary graft dysfunction • Donor lung injury