ALVEOLAR EXPANSION ITSELF BUT NOT CONTINUOUS OXYGEN-SUPPLY ENHANCES POSTMORTEM PRESERVATION OF PULMONARY GRAFTS

Citation
Dem. Vanraemdonck et al., ALVEOLAR EXPANSION ITSELF BUT NOT CONTINUOUS OXYGEN-SUPPLY ENHANCES POSTMORTEM PRESERVATION OF PULMONARY GRAFTS, European journal of cardio-thoracic surgery, 13(4), 1998, pp. 431-440
Citations number
30
Categorie Soggetti
Cardiac & Cardiovascular System
ISSN journal
10107940
Volume
13
Issue
4
Year of publication
1998
Pages
431 - 440
Database
ISI
SICI code
1010-7940(1998)13:4<431:AEIBNC>2.0.ZU;2-X
Abstract
Objective: If lungs could be retrieved for transplant after circulator y arrest, the shortage of donors might be significantly alleviated. Gr eat controversy still exists concerning the optimal mode of preservati on of pulmonary grafts in these non-heart-beating donors. Methods: Gra ft function was measured in an isolated room air-ventilated rabbit lun g model during reperfusion with homologous, diluted (Hb +/- 8.0 g/dl) and deoxygenated (PaO2 +/- 40 mmHg)blood up to 4 h. Five groups of cad avers (n = 4 in each group) were studied: In the control group, lungs were immediately reperfused. In the other groups, cadavers were left a t room temperature for 4 h after death with lungs either deflated (gro up 1), inflated with room air (group 2), or ventilated with room air ( group 3) or 100% nitrogen (group 4). Results: After 1 h of reperfusion , significant differences were noted between group 1 and groups 2, 3, and 4 in peak airway pressure (27 +/- 5 cm H2O vs. 15 +/- 1 cm H2O, 17 +/- 2 cm H2O, and 16 +/- 1 cm H2O, respectively; P < 0.05), in weight gain (137 +/- 24 vs. 31 +/- 7, 30 +/- 3, and 30 +/- 2%, respectively; P < 0.05), and in veno-arterial oxygen pressure gradient (9 +/- 5 vs. 95 +/- 13, 96 +/- 7 and 96 +/- 4 mmHg, respectively; P < 0.05). Also, wet-to-dry weight ratio at end of reperfusion was significantly diffe rent (10.2 +/- 1.0 vs. 6.0 +/- 0.3, 5.2 +/- 0.3 and 5.4 +/- 0.5, respe ctively; P < 0.05). No significant differences in any of these paramet ers were observed between groups 2, 3, and 4. Conclusions: These data suggest that: (1) pulmonary edema will develop in atelectatic lungs if reperfusion is delayed for 4 h after death; (2) postmortem room air-i nflation is as good as ventilation in prolonging warm ischemic toleran ce; (3) ventilation with room air is no different from that with nitro gen; (4) therefore? prevention of alveolar collapse appears to be the critical factor in protecting the warm ischemic lung from reperfusion injury independent of continuous oxygen supply. (C) 1998 Elsevier Scie nce B.V. All rights reserved.