Alveolar expansion itself but not continuous oxygen supply enhances postmortem preservation of pulmonary grafts1

Abstract

These data suggest that: (1) pulmonary edema will develop in atelectatic lungs if reperfusion is delayed for 4 h after death; (2) postmortem room air-inflation is as good as ventilation in prolonging warm ischemic tolerance; (3) ventilation with room air is no different from that with nitrogen; (4) therefore, prevention of alveolar collapse appears to be the critical factor in protecting the warm ischemic lung from reperfusion injury independent of continuous oxygen supply.

Primary Graft Dysfunction

“…73,[77][78][79][80] High oxygen tension in the hypothermic lung is associated with excess ROS generation and lung injury; therefore, the practice of inflated lung procurement with room air is supported by the finding that hypothermic, hyperoxic, atelectatic lungs have worse gas exchange, edema, and peak inspiratory pressure. 75,76,80,81 ROS generation is likely the direct result of tissue injury via oxidative damage to lipids, proteins, deoxyribonucleic acids, and biomolecules enhanced by the release of free iron Fe 2þ . 82 Indirect effects have been demonstrated where ROS can serve as a cellsignaling mediator responding to the loss of pulsatility by the amplification of downstream events results in endothelial activation.…”

Clinical lung transplantation from uncontrolled non–heart-beating donors revisited

“…[2][3][4][5][6][7] Various groups have recently reported on their early, limited experience with controlled NHBDs. 8 -16 Our group has focused on the uncontrolled counterparts, and in this report we provide an update on our early and long-term results in a series of 29 lung transplants from Maastricht Classification Category II NHBDs.…”

How long can we preserve the pulmonary graft inside the nonheart-beating donor?

“…For many years we have been exploring in our laboratory the possibility of using lungs from these donors. In previous rabbit studies we have investigated the effect of postmortem cadaver lung inflation, ventilation, and cooling [13][14][15][16] on the catabolism of adenine nucleotides [17,18], on pulmonary cell viability [15], and on graft function [19].…”