Document Detail


Retrograde flush following warm ischemia in the non-heart-beating donor results in superior graft performance at reperfusion.
MedLine Citation:
PMID:  19201425     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The use of non-heart-beating donors (NHBD) has been propagated as an alternative to overcome the scarcity of pulmonary grafts. The presence of postmortem thrombi, however, is a concern for the development of primary graft dysfunction. In this isolated lung reperfusion study, we looked at the need and the best route of preharvest pulmonary flush. METHODS: Domestic pigs were sacrificed by ventricular fibrillation and divided in 3 groups (n = 6 per group). After 1 h of in situ warm ischemia, lungs in group I were retrieved unflushed (NF). In group II, lungs were explanted after an anterograde flush (AF) through the pulmonary artery. Finally, in group III, lungs were explanted after a retrograde flush (RF) via the left atrium. After 3 h of cold storage, the left lung was assessed for 60 min in our ex vivo reperfusion model. Wet-to-dry weight ratio (W/D) was calculated after reperfusion. RESULTS: Pulmonary vascular resistance (dynes x sec x cm(-5)) was 1145 +/- 56 (RF) versus 1560 +/- 123 (AF) and 1435 +/- 95 (NF) at 60 min of reperfusion (P < 0.05). Oxygenation and compliance were higher and plateau airway pressure was lower in RF versus AF and NF, although the difference did not reach statistical significance. No differences in W/D were observed between groups after reperfusion. Histological examination revealed fewer microthrombi in the left lung in RF compared with AF and NF. CONCLUSION: RF of lungs from NHBD improves graft function by elimination of microthrombi from the pulmonary vasculature, resulting in lower pulmonary vascular resistance upon reperfusion.
Authors:
Caroline Van De Wauwer; Arne P Neyrinck; Nele Geudens; Filip R Rega; Geert M Verleden; Erik Verbeken; Toni E Lerut; Dirk E M Van Raemdonck
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-08-05
Journal Detail:
Title:  The Journal of surgical research     Volume:  154     ISSN:  1095-8673     ISO Abbreviation:  J. Surg. Res.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-11     Completed Date:  2009-07-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376340     Medline TA:  J Surg Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  118-25     Citation Subset:  IM    
Affiliation:
Laboratory for Experimental Thoracic Surgery, Katholieke Universiteit Leuven, Leuven, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Animals
Cadaver
Heart
Humans
Lung
Lung Compliance
Lung Transplantation / methods,  pathology,  physiology*
Organ Preservation / methods
Positive-Pressure Respiration
Pulmonary Artery / surgery
Pulmonary Circulation
Pulmonary Embolism / pathology
Reperfusion / methods*
Swine
Tissue Donors
Treatment Failure
Vascular Resistance

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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