Lung recruitment after cardiac arrest during procurement of atelectatic donor lungs is a protective measure in lung transplantation

Abstract

Background: Brain-dead donors are susceptible to pulmonary atelectasis (AT). In procurement surgery, lung recruitment under circulatory conditions and cold-flushing for atelectatic donor lungs often provoke graft injury due to the acute blood inflow. We hypothesized that lung recruitment without blood circulation can mitigate graft injury. This study aimed to examine the benefits of lung recruitment subsequent to cardiac arrest using a porcine lung-transplant model.Methods: Thirteen donor pigs were categorized into the non-atelectatic (No-AT) group (n=3) representing a healthy control group; AT-BCR group (n=5), in which AT was reverted by conventional blood-circulated recruitment (BCR); and AT-no-BCR group (n=5), in which AT was reverted by no-BCR following circulatory arrest. In the atelectatic donor models, the left main bronchus was ligated for 24 hours prior to lung procurement. Left lung transplantation (LTx) was subsequently performed in the thirteen recipient pigs. After 6 hours evaluation, the recipients were euthanized and the lung grafts were excised. Results:The post-transplant PaO 2 /FiO 2 ratio was significantly higher in the AT-no-BCR group than in the AT-BCR group (P=0.015). Wet/dry ratio, histological findings of graft injury and tissue interleukin-8 expression in the AT-no-BCR group were similar to those of the No-AT group.Conclusions: Lung recruitment without circulation after circulatory arrest could be more protective for atelectatic donor lung than the conventional procedure.

Donor lung inflation: are we doing it right?

“…While conditions were similar among all the groups this reaffirms that lung injury perhaps occurred while the atelectatic lungs were inflated under blood perfused conditions within the donor (4).…”

“…In the present manuscript Niman et al (4), have demonstrated that lung recruitment after cardiac arrest during donor lung procurement has a protective effect on both the donor lung as well as following transplant. The authors should be congratulated for their efforts to study an innovative method to mitigate donor lung damage during procurement and for the novel concept.…”

Lung Donor Selection and Management: An Updated Review

“…Tidal volume should be kept at 6 to 8 ml/kg as part of a lungprotective ventilation strategy. Prior to donor lung retrieval, hemodynamic and metabolic goals should be kept intact [94,95].…”

Donor lung preservation for transplantation—where do we go from here?

“…Recipient animal outcome during the first 6 hours was compared between two study groups following implantation of a 24-hour atelectatic left donor lung. The parenchyma was fully recruited either before versus after cardioplegic circulatory arrest prior to the start of cold pulmoplegia (25). The authors reported that posttransplant oxygenation capacity expressed as PaO 2 /FiO 2 ratio was significantly better in the group with lungs not recruited until after circulatory arrest (P=0.015).…”