Canine bilateral lung transplantation after 18-hour preservation using non-heart-beating donors.

BACKGROUND

We previously reported that lung inflation with oxygen, EPC-K1 (a diester alpha-tocopherol and ascorbic acid), urokinase and low-potassium dextran glucose (LPDG) solution can be beneficial in lung preservation. In the present study, a canine bilateral lung transplantation (BLT) model was used to evaluate long-term lung preservation of non-heart-beating donors (NHBDs).

METHODS

Animals were euthanized without heparinization and left at room temperature for 2 hours until lung extraction. After cardiac arrest, the lungs were kept inflated with 100% oxygen. After extraction, the donor lungs were flushed with LPDG solution containing EPC-K1 (1.0 mg/liter), followed by injection of urokinase (120,000 IU) into the pulmonary artery. Eighteen BLTs were performed after preservation at 4 degrees C. Total ischemic time was scheduled for 12 hours in Group 1 (n = 6), 18 hours in Group 2 (n = 6) and 24 hours in Group 3 (n = 6). After BLT, recipients were followed up for 6 hours. An additional 6 BLTs were performed as a chronic study in the same setting as for Group 2.

RESULTS

All animals in Groups 1 and 2 showed excellent pulmonary function during the 6-hour post-transplant assessment time, in contrast to only 2 dogs from Group 3. In the chronic study, all 6 animals showed excellent pulmonary function for 24 hours (PaO2 = 528 +/- 8 mm Hg with 100% oxygen) and 2 of them survived for >1 week.

CONCLUSION

Successful chronic lung preservation (18 hours) using NHBDs is achievable in a canine BLT model.