Oar. Binns et al., IMPAIRED BRONCHIAL HEALING AFTER LUNG DONATION FROM NON-HEART-BEATINGDONORS, The Journal of heart and lung transplantation, 15(11), 1996, pp. 1084-1092
Background: Bronchial viability after lung transplantation remains a c
oncern. Modern preservation methods, surgical technique, and limited c
old ischemic periods have decreased the frequency of bronchial complic
ations. However, lungs procured from non-heart-beating donors are subj
ected to a mandatory period of warm ischemia. We investigated bronchia
l healing in a porcine survival model of left lung transplantation usi
ng organ procurement from non-heart-beating donors after a 60-minute p
eriod of warm ischemia. Methods: Fourteen adult domestic swine underwe
nt left lung transplantation. All lungs were preserved with cold Euro-
Collins flush and stored inflated at 4 degrees C. Control lungs (n = 5
) were flushed, harvested, and stored for 2 hours before implantation.
Experimental lungs (n = 9) were procured from non-heart-beating donor
s. These lungs were subjected to 60 minutes of warm ischemia before fl
ush and harvest, followed by 2 hours of cold storage before implantati
on. After 21 days of immunosuppression with prednisone, azathioprine,
and cyclosporine, pulmonary function was assessed. Bronchial viability
was evaluated with bronchoscopy and, at autopsy, followed by histolog
ic analysis. Results: Implantation time did not differ significantly b
etween the control group and the experimental group (59.6 +/- 2.1 vers
us 64.4 +/- 2.9 minutes, p = 0.24). Control swine exhibited no evidenc
e of ischemic injury to the donor bronchus. In contrast, six of nine l
ungs procured from non-heart-beating donors showed evidence of ischemi
c bronchial injury (p = 0.031 versus control). Findings ranged from hy
povascular edematous mucosa to necrosis and sloughing of the mucosa th
roughout the entire donor bronchial tree. The remaining three non-hear
t-beating donor lungs exhibited normal lung function and bronchial hea
ling. Conclusions: We conclude that 60 minutes of warm ischemia for lu
ngs procured from non-heart-beating donors results in impaired bronchi
al viability with current preservation techniques. Thirty minutes of w
arm ischemia may be the acceptable limit for lung procurement from non
-heart-beating organ donors.