LATE BREAKING I

J. Sakamoto, T. Yamada, F. Chen, D. Nakajima, R. Kikuchi, F. Kojima, A. Osumi, A. Takahashi, N. Satoda, T. Fujinaga, T. Shoji, H. Sakai, T. Bando, H. Date
Thoracic Surgery, Kyoto University, Kyoto/JAPAN

Body: Introduction: Lung transplantation from donation after cardiac death (DCD) donors has started to be performed to alleviate the chronic shortage of donors all over the world. However, in DCD donors, pulmonary dysfunction related to circulatory arrest, namely, warm ischemia should be considered. In medium and large animal models, it has been reported that 240-min warm ischemic time (WIT) might be the limit of WIT and continuous ventilation from the onset of warm ischemia to procurement was necessary in 240-min WIT. In so-called uncontrolled DCD donors, ventilation can not always be performed continuously from the onset of the cardiac arrest during WIT. Therefore, we investigated the protective effect of the last 60-min of ventilation during 240-min WIT. Methods: Donor dogs were sacrificed using intravenous potassium chloride without heparinization and left at room temperature. Ventilation group (n=5) received ventilation with 100% oxygen for 60 min starting 180 min after cardiac arrest. Non-ventilation group (n=5) did not receive any ventilation for 240 min after cardiac arrest. In each group, pulmonary arterial flush was performed 240 min after cardiac arrest and then the harvested organ was preserved at 4^oC for 120 min. In recipient dogs, single left lung transplantation was performed. The right pulmonary artery was ligated 60 min after reperfusion in order to evaluate the left transplanted lung function. Results: In the ventilation group, all 5 animals survived 240 min after reperfusion, while in the non-ventilation group, only 3 survived and the other two died of circulatory collapse 75 min and 120 min after reperfusion. The ventilation group demonstrated better pulmonary oxygenation, shunt fraction, wet/dry weight ratio, and ATP levels in the lung tissue (p<0.05). Furthermore, in the non-ventilation group, histological findings showed severe intraparenchymal hemorrhage and inflammation. Conclusion: These findings suggested that ventilation for a certain period of time before procurement might ameliorate ischemia-reperfusion injury in DCD donors.

Disclosure: All authors have declared no conflicts of interest.