Evaluation of Techniques for Lung Transplantation Following Donation After Cardiac Death

Gregory I. Snell, Takahiro Oto, Bronwyn Levvey, Robin McEgan, Mark Mennan, Takao Higuchi, Leif Eriksson, Trevor J. Williams, Franklin Rosenfeldt

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: Lung transplantation using "donation after cardiac death" donors is a potential means to alleviate the shortage of suitable donor lungs for transplantation, but the practicality and utility of the various possible techniques need to be clarified. Methods: Using a dog model, we explored seven variations of standoff (ischemic) time (50 to 240 minutes), topical cooling (60 to 120 minutes), and flush cooling and cold storage (30 to 140 minutes) to mimic different human donor lung retrieval scenarios that can follow donation after cardiac death. The functional status of donation after cardiac death donor lungs was assessed initially with a 250 mL pulmonary arterial blood flush while ventilating with 100% oxygen and then on an ex-vivo perfusion rig for 120 minutes after retrieval. Results: All lungs achieved an excellent pO2/FiO2 ratio ranging from 472 to 586 with stable pulmonary artery pressures and pulmonary vascular resistance and no net weight gain (952 ± 221 g versus 1,006 ± 235 g) during the 120-minute evaluation period. Initial blood flush correlated well with measured perfusion rig pO2 at 30 minutes (R2 = 0.63). Conclusions: This canine study suggests that lungs donated after cardiac death are reproducibly useable for transplantation with ischemic times of as long as 60 minutes. Although more study is needed, a blood flush evaluation is simple and may have a role as a secondary allograft assessment tool. The existing techniques of donor lung evaluation and preservation after donation following cardiac death thus appear both feasible and practical.

Original languageEnglish
Pages (from-to)2014-2019
Number of pages6
JournalAnnals of Thoracic Surgery
Volume81
Issue number6
DOIs
Publication statusPublished - Jun 2006
Externally publishedYes

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Lung Transplantation
Lung
Perfusion
Vascular Resistance
Pulmonary Artery
Weight Gain
Allografts
Canidae
Transplantation
Dogs
Oxygen
Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Evaluation of Techniques for Lung Transplantation Following Donation After Cardiac Death. / Snell, Gregory I.; Oto, Takahiro; Levvey, Bronwyn; McEgan, Robin; Mennan, Mark; Higuchi, Takao; Eriksson, Leif; Williams, Trevor J.; Rosenfeldt, Franklin.

In: Annals of Thoracic Surgery, Vol. 81, No. 6, 06.2006, p. 2014-2019.

Research output: Contribution to journalArticle

Snell, GI, Oto, T, Levvey, B, McEgan, R, Mennan, M, Higuchi, T, Eriksson, L, Williams, TJ & Rosenfeldt, F 2006, 'Evaluation of Techniques for Lung Transplantation Following Donation After Cardiac Death', Annals of Thoracic Surgery, vol. 81, no. 6, pp. 2014-2019. https://doi.org/10.1016/j.athoracsur.2006.01.014
Snell, Gregory I. ; Oto, Takahiro ; Levvey, Bronwyn ; McEgan, Robin ; Mennan, Mark ; Higuchi, Takao ; Eriksson, Leif ; Williams, Trevor J. ; Rosenfeldt, Franklin. / Evaluation of Techniques for Lung Transplantation Following Donation After Cardiac Death. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 6. pp. 2014-2019.
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