HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Arne P. Neyrinck Filip R. Rega Dirk E.M. Van Raemdonck Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Van De Wauwer, C. Articles by Van Raemdonck, D. E.M. Search for Related Content PubMed PubMed Citation Articles by Van De Wauwer, C. Articles by Van Raemdonck, D. E.M. Related Collections Lung - transplantation Lung - basic science

Eur J Cardiothorac Surg 2007;31:1125-1133. doi:10.1016/j.ejcts.2007.01.070
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Retrograde flush following topical cooling is superior to preserve the non-heart-beating donor lung

^a Laboratory for Experimental Thoracic Surgery, KU Leuven, Belgium
^b Laboratory for Pneumology, KU Leuven, Belgium
^c Department of Morphology and Molecular Pathology, UZ Leuven, Belgium
^d Department of Thoracic Surgery, UZ Leuven, Belgium

Received 1 September 2006; received in revised form 14 January 2007; accepted 22 January 2007.

^_* Corresponding author. Address: Department of Thoracic Surgery, University Hospital Gasthuisberg, 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 propagated as an alternative to overcome the scarcity of pulmonary grafts. Formation of microthrombi after circulatory arrest, however, is a major concern for the development of reperfusion injury. We looked at the effect and the best route of pulmonary flush following topical cooling in NHBD. Methods: Non-heparinized pigs were sacrificed by ventricular fibrillation and divided into three groups (n = 6 per group). After 1 h of in situ warm ischaemia and 2.5 h of topical cooling, lungs in group I were retrieved unflushed (NF). In group II, lungs were explanted following an anterograde flush (AF) through the pulmonary artery with 50 ml/kg Perfadex^® (6 °C). Finally, in group III, lungs were retrieved after an identical but retrograde flush (RF) via the left atrium. Flush effluent was sampled at intervals to measure haemoglobin concentration. Performance of the left lung was assessed during 60 min in our ex vivo reperfusion model. Wet-to-dry weight ratio (W/D) of both lungs was calculated as an index of pulmonary oedema. IL-1ß and TNF- protein levels in bronchial lavage fluid from both lungs were compared between groups. Results: Haemoglobin concentration (g/dl) was higher in the first effluent in RF versus AF (3.4 ± 1.1 vs 0.6 ± 0.1; p < 0.05). Pulmonary vascular resistance (dynes x s x cm^–5) was 975 ± 85 RF versus 1567 ± 98 AF and 1576 ± 88 NF at 60 min of reperfusion (p < 0.001). Oxygenation (mmHg) and compliance (ml/cmH₂O) were higher (491 ± 44 vs 472 ± 61 and 430 ± 33 NS, 22 ± 3 vs 19 ± 3 and 14 ± 1 NS, respectively) and plateau airway pressure (cmH₂O) was lower (11 ± 1 vs 13 ± 1 and 13 ± 1 NS) after RF versus AF and NF, respectively. No differences in cytokine levels or in W/D ratios were observed between groups after reperfusion. Histology demonstrated microthrombi more often present after AF and NF compared to RF. Conclusion: Retrograde flush of the lung following topical cooling in the NHBD results in a better washout of residual blood and microthrombi and subsequent reduced pulmonary vascular resistance upon reperfusion.

Key Words: Lung transplantation • Non-heart-beating donor • Pulmonary flush

This article has been cited by other articles:

				G. Lang, C. Aigner, G. Winkler, K. Shkirdladze, W. Wisser, G. Dekan, M. Tamura, G. Heinze, D. Van Raemdonck, and W. Klepetko Prolonged venoarterial extracorporeal membrane oxygenation after transplantation restores functional integrity of severely injured lung allografts and prevents the development of pulmonary graft failure in a pig model. J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1493 - 1498. [Abstract] [Full Text] [PDF]

				P. A. Corris and J. D. Christie Update in Transplantation 2007 Am. J. Respir. Crit. Care Med., May 15, 2008; 177(10): 1062 - 1067. [Full Text] [PDF]