Lung transplantation from ventilated non-heart-beating donors: Experimental study in a neonatal swine model

Lung Retrieval from Non-Heart-Beating Donors: First Experience with an Innovative Preservation Strategy in a Pig Lung Transplantation Model

“…This edema formation correlates with the significantly increased pulmonary vascular resistance in NHBD lungs and represents a mild form of ischemia/reperfusion injury. Of special clinical importance and one of the main results of the presented work is the finding of continuous washout of small blood and fibrin clots from the pulmonary arterial venting site during retrograde preservation, although all donor animals in our series received intravenous heparin prior to cardiac arrest as recommended by several groups [18,26,38]. This phenomenon underlines that even with heparinization the pulmonary circulation is still prone to some degree of microvascular thrombosis which can alter the postoperative outcome following lung transplanta-tion.…”

“…The lung is unique among the vital organs owing to its remarkable tolerance to warm ischemia which is premised on the fact that pulmonary parenchymal cells are able to maintain aerobic metabolism with alveolar oxygen even after cessation of vascular circulation [6,7,17]. In the last years, several authors have investigated the tolerance of ventilated lung grafts to different periods of warm ischemia with promising overall results [18][19][20][21]. However, although the pulmonary vascular endothelium is considered to maintain its function over several hours of warm ischemia [22,23], diffuse microvascular thrombosis in the pulmonary circulation is thought to represent a serious and clinically limiting problem with the use of NHBD grafts [4,24].…”

Donor pretreatment using the aerosolized prostacyclin analogue iloprost optimizes post-ischemic function of non-heart beating donor lungs

“…6,7,23 In the last few years, several authors have investigated the tolerance of ventilated lung grafts to different periods of WIT, with overall promising results. 8,24,25,9 However, although the pulmonary vascular endothelium is considered to maintain its function over several hours of WIT, 26,27 diffuse microvascular thrombosis in the pulmonary circulation is considered to represent a serious and clinically limitating problem encountered with the use of NHBD grafts. 4,28,29 Recently, the innovative approach of retrograde preservation of lung grafts has been shown to be very effective in elimination of different kinds of thrombi from the pulmonary vasculature in combination with a significantly improved preservation quality.…”

“…8,9 Although intravenous prostanoids are routinely used in thoracic organ transplantation to ameliorate reperfusion injury, 10,11 the latest evidence suggests a similar efficacy of inhaled prostacyclin and its analogues. 12,13 Aerosolization of iloprost causes marked pulmonary vasodilatation, especially in well-ventilated pulmonary regions, with maintenance of pulmonary gas exchange and systemic arterial pressure.…”

“…6,7 However, because of the potentially deleterious effects of extended warm ischemia on microvascular integrity, use of NHBD lungs is limited by short tolerable time periods before preservation. 8,9 After intravenous prostanoids are routinely used to ameliorate reperfusion injury in thoracic organ transplantation, 10,11 the latest evidence suggests similar efficacy of inhaled prostacyclin and its analogues. 12,13 Because there is no information in the world literature so far, we thought to evaluate the impact of donor pretreatment with the aerosolized prostacyclin analogue iloprost by means of a novel mobile ultrasonic nebulizer on postischemic NHBD lung function as the main purpose of this study.…”