Warm ischemic time tolerance after ventilated non-heart-beating lung donation in piglets1

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Abstract
The availability of lungs for transplantation could be ameliorated with the use of organs retrieved from ventilated non-heart-beating donors (VNHBD). The aim of this work is to determine the limit to tolerable in situ warm ischemia time (WIT) for lung grafts after circulation is stopped. Twenty piglets underwent left lung allotransplantation. Animals were randomly allocated based on the donor's status 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. Right pulmonary artery and bronchus were permanently occluded one hour after transplantation. Assessment of pulmonary function was monitored hourly by hemodynamic, oxygenation and pulmonary mechanic measurements during a period of 6 h after reperfusion. Lung grafts were weighed pre- and post-transplantation. Cold ischemic time was similar for all groups, and averaged 80.1+/-2.7 min. Final mean lung weight was 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 rise in airway resistance and a fall in compliance. Post-transplantation lung graft function from VNHBD with up to 90 min of WIT, is equivalent to those achieved by grafts harvested after heart-beating donation. This method may be a promising strategy of increasing the pulmonary donor pool.