PDE-5 inhibitor donor intravenous preconditioning is superior to supplementation in standard preservation solution in experimental lung transplantation☆

Abstract

Sildenafil allows for a better graft function after 24 h ischemia when given prior to standard flushing and preservation. This effect can be explained by a complete/homogenous preservation achieved by selective pulmonal vasodilatation. However, this effect seems to persist when sildenafil remains in the storage solution, leading to severe pulmonary edema.

Technical Pearls for Swine Lung Transplantation

“…An adequate understanding of pig lung anatomy is important for those beginning experimental protocols. In our review of the literature, we could not find an article dedicated to the technique of swine lung transplantation; nevertheless, several articles briefly describe their donor and recipient preparation [1,[7][8][9][10]12]. In our described model, a single stage cross-clamp is applied to the left pulmonary hilum and obviates the need for sequential clamping.…”

“…Some authors do not exclude the recipient's native right lung from the circulation or ventilation during assessments [7]. Others prefer to ligate the right pulmonary artery shortly after reperfusion so that the recipient pig is solely dependent on the transplanted lung during assessments [9,10,12]; however, it is unlikely that pigs will tolerate reperfusion times in excess of 1-2 h following right pulmonary artery ligation as there is then massive shunting of the entire cardiac output to the donor lung, which has already sustained endothelial damage during cold ischemia, with subsequent lung edema, hypoxemia, and death [9]. Some xenotransplantation models employing right pulmonary artery ligation have 100% mortality in the control group within 20 s of occlusion [12]; however, in an allotransplantation model, Pizanis et al have reported 100% (n ¼ 7) survival in the control group during 6 h of reperfusion with the right pulmonary artery and bronchus ligated 10-20 min after reperfusion [12].…”

“…Swine is the most commonly used large animal model of lung transplantation; often in studies of drug effects on ischemia/reperfusion injury [3,[7][8][9][10], EVLP [1,3] and in xenotransplantation [11,12]. An adequate understanding of pig lung anatomy is important for those beginning experimental protocols.…”

“…We also differ in the order of performing the anastomoses as venous is performed first, followed by bronchial and arterial. Others have suggested ligation of the left pulmonary veins, followed by clamping of the left bronchus and pulmonary artery and cutting them distally for left pneumonectomy; with subsequent performance of the bronchial and arterial anastomoses in sequence and then clamping the recipient's left atrium that is sewed to the donor's left atrial cuff [8,10].…”

“…Oxygenation capacity (PaO 2 /FiO 2 ) with arterial blood gases, pulmonary artery pressures and vascular resistance, and dynamic and static lung compliance are used to monitor the transplanted lung performance during reperfusion [1,[7][8][9][10][11][12]. There are three approaches to monitor the transplanted lung.…”