Reliable thirty-hour lung preservation by donor lung hyperinflation

Area of Science:

• Thoracic surgery
• Transplantation immunology
• Pulmonary medicine

Background:

• Lung preservation is critical for successful allografting.
• Donor lung inflation strategy at harvest may influence post-transplant outcomes.
• Optimizing lung preservation techniques is essential for improving graft function and patient survival.

Purpose of the Study:

• To investigate the impact of donor lung inflation degree during harvest on postpreservation lung function.
• To evaluate the efficacy of hyperinflation techniques, with or without prostaglandin E1, in preserving lung viability for transplantation.

Main Methods:

• Donor dog lungs were assigned to groups: hyperinflated with (Group 1) or without (Group 2) prostaglandin E1, or normally ventilated without hyperinflation (Group 3).
• Lungs underwent hypothermic pulmonary artery flush with modified Euro-Collins solution and were stored for approximately 29 hours.
• Left single lung allografting was performed, with recipient pulmonary artery occlusion to allow independent transplanted lung assessment.

Main Results:

• Hyperinflated lungs (Groups 1 and 2) demonstrated excellent early post-transplant function, with high arterial oxygen tension (503 ± 45 and 529 ± 150 mm Hg, respectively).
• Non-hyperinflated lungs (Group 3) showed significantly lower arterial oxygen tension (116 ± 78 mm Hg) and developed pulmonary edema.
• Recipient survival was 100% in Groups 1 and 2 over 3 days, compared to 60% in Group 3, with two deaths due to perfusion difficulties.

Conclusions:

• Donor lung hyperventilation and inflation to 30 cm H2O before hypothermic storage significantly improve post-transplantation lung function after prolonged preservation.
• This hyperinflation technique is effective with or without prostaglandin E1 pretreatment.
• Potential mechanisms include improved pulmonary vascular tone and surfactant metabolism due to increased lung volume.