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Ex vivo lung evaluation of prearrest heparinization in donation after cardiac death
- Source :
- Annals of surgery. 257(3)
- Publication Year :
- 2012
-
Abstract
- To evaluate the effects of prearrest heparin administration on lung quality in a model of donation after cardiac death (DCD), and to assess the potential application of ex vivo lung perfusion (EVLP) in the identification of better grafts from the DCD donor pool.Cardiac death was induced by electric shock in 10 pigs. One group received a prearrest heparin dose of 300 units/kg (H group, n = 5) and the other did not (NH group, n = 5). Animals remained at room temperature for 1 hour without ventilation, defining the warm ischemic time. After harvest, the lungs underwent 6 hours of cold ischemia before being evaluated with EVLP for 4 hours.Static compliance 28 ± 3 versus 29 ± 2 (Cstat-cm H2O), pulmonary vascular resistance (PVR) 593 ± 127 versus 495 ± 70 (PVR-dyn·s/cm), and oxygenation 327 ± 32 versus 330 ± 28 (ΔPO2-mm Hg) remained stable from the beginning until the end of EVLP in the H group. In the NH group, Cstat started to decline after the first hour (25 ± 2 vs 21 ± 2), ΔPO2 after hour 2 (265 ± 44 vs 207 ± 44), and PVR started to increase after hour 3 (765 ± 132 vs 916 ± 168). Significant differences between the groups were observed at the end of EVLP (P0.001). Parameters of lung quality after EVLP also showed significant differences between the groups: wet weight-to-dry weight ratio (P0.001), protein in the bronchial lavage (P0.01), Na + K-ATPase activity (P0.001), and E-selectin (P0.001) in the perfusate.Prearrest heparin administration improved organ function by preserving endothelial homeostasis. EVLP proved to be a useful platform for assessing DCD lungs, providing reliable means of discriminating injured grafts.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Swine
Organ Preservation Solutions
Internal medicine
Medicine
Animals
Warm Ischemia
Lung
business.industry
Heparin
Ex vivo lung perfusion
Cold Ischemia
Anticoagulants
Donation after cardiac death
respiratory system
Tissue Donors
Heart Arrest
Cold Temperature
Perfusion
Disease Models, Animal
medicine.anatomical_structure
Anesthesia
Cardiology
Surgery
Vascular Resistance
business
Ex vivo
medicine.drug
Lung Transplantation
Subjects
Details
- ISSN :
- 15281140
- Volume :
- 257
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Annals of surgery
- Accession number :
- edsair.doi.dedup.....23d5c55c682848cf44d47a938a5a4720