Pre-arrest heparinization and ventilation during warm ischemia preserves lung function in non-heart-beating donors

Boglione, Mariano; Morandini, M; Barrenechea, Marcelo; Rubio, R; Aguilar, Delio

doi:10.1016/s0022-3468(99)90317-2

Cited by 16 publications

(17 citation statements)

References 23 publications

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“…However, about 35 000 people in the US are killed from firearms while 47 000 deaths are related to motor vehicle accidents [145]. If just some of these acutely injured people after unsuccessful resuscitation were candidates for nonheart-beating organ donation, this might increase the number of available organs by up to 20-30% [146,147]. In 1995, at the first international workshop on NHBD in Maastricht, consensus was reached about donor management protocols, and four different categories of NHB donors were defined as the so-called 'Maastricht classification' [148].…”

Section: Nonheart-beating Donors (Nhbd)mentioning

confidence: 99%

Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience

Wittwer

Wahlers

2007

Transplant International

108

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Section: Nonheart-beating Donors (Nhbd)mentioning

confidence: 99%

Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience

Wittwer

Wahlers

2007

Transplant International

108

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“…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].…”

Section: Commentmentioning

confidence: 99%

“…However, it is estimated that 35,000 people in the US are killed by firearms, and 47,000 deaths are related to motor vehicle accidents [3]. If, after unsuccessful resuscitation, just a small portion of these acutely injured people were candidates for non-heartbeating organ donation, this might increase the number of available organs by up to 20-30% [4,5]. Lung retrieval from non-heart-beating donors (NHBDs) is considered to be a realistic therapeutic option as the lung is unique among the transplanted solid organs in that it is not dependent on vascular perfusion to meet its oxygen needs.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2004

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Objective: Lung transplantation is limited by the scarcity of donor organs. Lung retrieval from non-heart-beating donors (NHBD) might extend the donor pool and has been reported recently. However, no studies in NHBD exist using the novel approach of retrograde preservation with Perfadex solution. Methods: Heparinized asystolic pigs (n = 5, 30–35 kg) were ventilated for 90 min. The lungs were retrogradely preserved with Perfadex solution and stored inflated at 4°C for 3 h. Left lung transplantation in the recipient was followed by exclusion of the right lung. Results were compared to sham-operated animals. Oxygenation, hemodynamics and dynamic compliance were monitored for 4 h. Infiltration of polymorphonuclear cells (PMNs) and stereological quantification of alveolar edema was performed. Statistical analysis comprised Kruskal-Wallis and Mann-Whitney tests and ANOVA analysis with repeated measures. Results: No mortality was observed. During preservation, continuous elimination of blood clots via the pulmonary artery venting site was observed. Oxygenation and compliance were similar between groups, but sham controls showed significantly lower pulmonary vascular resistance. Stereological quantification revealed higher volume fractions of intra-alveolar edema in NHBD grafts, while PMN infiltration was comparable to sham controls. Conclusions: Use of NHBD lungs results in excellent outcome after 90 min of warm ischemia followed by retrograde preservation with Perfadex solution. This novel approach can optimize lung preservation by eliminating clots from the pulmonary circulation and might clinically be considered in brain-dead organ donors who become hemodynamically unstable prior to organ harvest. Further trials with longer warm and cold ischemic periods are necessary to further elucidate this promising approach to donor pool expansion.

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“…However, it is estimated that 35,000 people in the US are killed from firearms while 47,000 deaths are related to motor vehicle accidents [2]. If just a small portion of these acutely injured people after unsuccessful resuscitation were candidates for non-heartbeating organ donation, this might increase the number of available organs by up to 20 -30% [3,4]. Lung retrieval from non-heart-beating donors (NHBD) is considered to be a realistic therapeutic option as the lung is unique among the transplanted solid organs in the way that it is not dependent on vascular perfusion to meet its oxygen needs.…”

Section: Introductionmentioning

confidence: 99%

Innovative pulmonary preservation of non-heart-beating donor grafts in experimental lung transplantation1

Wittwer

Franke

Fehrenbach³

et al. 2004

European Journal of Cardio-Thoracic Surgery

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Use of NHBD lungs is feasible and results in similar postischemic outcome when compared to sham-controls and standard preservation procedures even after 5 h of pre-harvest warm ischemia. Especially, the NHBD with high-risk constellations for intravascular coagulation might benefit from retrograde preservation by elimination of thrombi from the pulmonary circulation. This innovative technique might also be considered in situations, where brain-dead organ donors become hemodynamically unstable prior to onset of organ harvest. Further trials with longer warm and cold ischemic periods are initiated to further elucidate this promising approach of donor pool expansion.

show abstract

Pre-arrest heparinization and ventilation during warm ischemia preserves lung function in non-heart-beating donors

Cited by 16 publications

References 23 publications

Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience

Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience

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

Innovative pulmonary preservation of non-heart-beating donor grafts in experimental lung transplantation1

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