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

Background/Purpose: A shortage of transplantable lungs is a constant and fr ustrating reality. The use of organs retrieved from ventilated non-heart-be ating donors (VNHBD) may alleviate this problem. The purpose of this work w as to assess lung function of donor grafts subjected to different time leng ths of in situ warm ischemia (WIT). Methods: Twenty piglets weighing between 6 and 8 kg were allocated randomly to the following study groups: Sham (n = 5), heart-beating donors, non war m ischemia; I-30 (n = 5), I-60 (n = 5) and I-90 (n = 5), VNHBD-WIT of 30, 6 0, and 90 minutes, respectively. Recipients were rendered dependent on the single left transplanted lung by clamping right pulmonary artery and bronch us 1 hour after transplantation. Assessment of pulmonary function was monit ored hourly by hemodynamic, oxygenation, and pulmonary mechanic measurement s during a period of 6 hours after reperfusion. Lung grafts were weighed pr e- and posttransplantation. Results: Final mean lung weight was significantly greater in VNHBD (92.5 +/ - 3.1 v Sham values 75.6 +/- 2.4; P < .01). Cold ischemic time averaged 80. 1 +/- 2.7 minutes. After right lung exclusion, hemodynamic changes consiste d of a sustained increase in pulmonary vascular resistance and a reduction in cardiac output. Lung mechanics also deteriorated with a gradual rise in airway resistance and a fall in compliance. Conclusions: These data suggest that posttransplantation lung graft functio n from VNHBD with up to 90 minutes of WIT, is preserved and equivalent to t hose achieved by grafts harvested after heart-beating donation. J Pediatr S urg 34:360-366. Copyright (C) 1999 by W.B. Saunders Company.