Tolerable Duration of Warm Ischaemia After Circulatory Death Is Safe For At Least One Hour in Porcine Lungs: Functional Assessment with Ex Vivo Lung Perfusion

Authors

  • Mathilde M. B. Hebsgaard, MD Department of Cardiothoracic Surgery, Copenhagen University Hospital, University of Copenhagen, Denmark
  • Hannelouise Kissow, MD, PhD NNF Center of Basic Metabolic Research and Department of Biomedical Sciences, University of Copenhagen, Denmark
  • Nikolaj B. Lilleør, RC Department of Cardiothoracic Surgery, Copenhagen University Hospital, University of Copenhagen, Denmark
  • Ulver S. Lorenzen, MD Department of Cardiothoracic Surgery, Copenhagen University Hospital, University of Copenhagen, Denmark
  • Raphaelle A. Chemtob, MD Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  • Hasse Møller-Sørensen, MD Department of Cardiothoracic Anaesthesiology, Rigshospitalet, University of Copenhagen, Denmark
  • Peter S. Olsen, MD, PhD Department of Cardiothoracic Surgery, Copenhagen University Hospital, University of Copenhagen, Denmark
  • Christian H. Møller, MD, PhD Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

DOI:

https://doi.org/10.1532/hsf.4347

Keywords:

Donation after circulatory death, lung donation, Ex-vivo lung perfusion, warm ischemia, animal experimental model

Abstract

Background: Lungs from donation after circulatory death (DCD) may be an underused resource for transplantation. The aim was to investigate, with a DCD pig model, if it was possible to recondition lungs exposed for up to 2 h of warm ischaemia with ex vivo lung perfusion (EVLP).

Methods: Danish domestic pigs (N = 17) were randomized into three groups. In the two study groups, lungs were exposed to either 1 or 2 h of warm ischaemia. All lungs were reconditioned and evaluated after 83 ± 38 minutes of perfusion at FiO2 1.0 and 0.21 with EVLP. Outcome measures were gas exchange, pulmonary physiology, inflammatory markers, and histopathologic assessment score.

Results: Lungs exposed for 2 h of warm ischaemia did not meet the criteria: PaO2 > 13 kPa required for donation compared with lungs subjected to 0 and 1 h of warm ischaemia (11.0 kPa vs. 14.2 kPa, P < 0.001). These lungs also developed an increased amount of foam and fluid in the airways. No differences in PaCO2, compliance, or pulmonary vascular resistance were observed.

Conclusion: Results show that while lungs subjected to 0 or 1 h of warm ischaemia meet the criteria for transplantation based on EVLP evaluation, lungs subjected to 2 h of warm ischaemia did not.

Author Biography

Nikolaj B. Lilleør, RC, Department of Cardiothoracic Surgery, Copenhagen University Hospital, University of Copenhagen, Denmark

RC

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Published

2022-01-17

How to Cite

Hebsgaard, M., Kissow, H., B. Lilleør , N., S. Lorenzen , U., A. Chemtob , R., Sørensen, H., S. Olsen, P., & H. Møller , C. (2022). Tolerable Duration of Warm Ischaemia After Circulatory Death Is Safe For At Least One Hour in Porcine Lungs: Functional Assessment with Ex Vivo Lung Perfusion. The Heart Surgery Forum, 25(1), E048-E052. https://doi.org/10.1532/hsf.4347

Issue

Vol. 25 No. 1 (2022)

Section

Article
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