WARM ISCHEMIC TIME TOLERANCE AFTER VENTILATED NON-HEART-BEATING LUNG DONATION IN PIGLETS

Objective: The availability of lungs for transplantation could be amel iorated with the use of organs retrieved from ventilated non-heart-bea ting donors (VNHBD). The aim of this work is to determine the limit to tolerable in situ warm ischemia time (WIT) for lung grafts after circ ulation is stopped. Methods: Twenty piglets underwent left lung allotr ansplantation. Animals were randomly allocated based on the donor's st atus before lung harvesting into the following study groups: Sham (n = 5), Heart-beating donors - non-warm ischemia; I-30 (n = 5), I-60 (n = 5) and I-90 (n = 5), VNHBD-WIT of 30, 60 and 90 min, respectively. Ri ght pulmonary artery and bronchus were permanently occluded one hour a fter transplantation. Assessment of pulmonary function was monitored h ourly by hemodynamic, oxygenation and pulmonary mechanic measurements during a period of 6 h after reperfusion. Lung grafts were weighed pre - and post-transplantation. Results: Cold ischemic time was similar fo r all groups, and averaged 80.1 +/- 2.7 min. Final mean lung weight wa s significantly greater in VNHBD (92.5 +/- 3.1 g vs. Sham values 75.6 +/- 2.4 g, P < 0.01). After right lung exclusion, hemodynamic changes consisted of a sustained increase in pulmonary vascular resistance and a reduction in cardiac output. Lung mechanics also modified, with a r ise in airway resistance and a fall in compliance. Conclusions: Post-t ransplantation lung graft function from VNHBD with up to 90 min of WIT , is equivalent to those achieved by grafts harvested after heart-beat ing donation. This method may be a promising strategy of increasing th e pulmonary donor pool. (C) 1998 Elsevier Science B.V. All rights rese rved.