Title: Retrograde flush following warm ischemia in the non-heart-beating donor results in superior graft performance at reperfusion
Authors: Van De Wauwer, Caroline ×
Neyrinck, Arne
Geudens, Nele
Rega, Filip
Verleden, Geert
Verbeken, Eric
Lerut, Antoon
Van Raemdonck, Dirk #
Issue Date: Jun-2009
Publisher: Elsevier
Series Title: The Journal of Surgical Research vol:154 issue:1 pages:118-25
Abstract: 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.
ISSN: 0022-4804
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Pneumology
Facility for Surgery and Anaesthesiology
Thoracic Surgery
Clinical Cardiac Surgery
Translational Cell & Tissue Research
× corresponding author
# (joint) last author

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