Impaired bronchial healing after lung donation from non-heart-beating donors

Area of Science:

• Transplantation immunology
• Surgical research
• Organ preservation

Background:

• Bronchial viability is critical for successful lung transplantation outcomes.
• Modern techniques have reduced bronchial complications, but warm ischemia in non-heart-beating donors remains a challenge.
• This study addresses bronchial healing following lung transplantation from donors with a warm ischemia period.

Purpose of the Study:

• To investigate bronchial healing and viability in a porcine model after left lung transplantation.
• To evaluate the impact of 60 minutes of warm ischemia on donor lungs from non-heart-beating donors.
• To determine acceptable warm ischemia limits for lung procurement.

Main Methods:

• Left lung transplantation performed in 14 adult swine.
• Lungs preserved with cold Euro-Collins flush and 2 hours cold storage.
• Experimental group: 60 minutes warm ischemia in non-heart-beating donors (n=9); Control group: no warm ischemia (n=5).
• Post-transplant assessment included pulmonary function, bronchoscopy, and histology after 21 days of immunosuppression.

Main Results:

• No significant difference in implantation time between groups.
• Control lungs showed no ischemic injury.
• Six of nine (67%) lungs from non-heart-beating donors exhibited ischemic bronchial injury, ranging from mucosal edema to necrosis.
• Three non-heart-beating donor lungs showed normal function and healing.

Conclusions:

• Sixty minutes of warm ischemia significantly impairs bronchial viability in lungs from non-heart-beating donors.
• Current preservation techniques are insufficient to mitigate 60 minutes of warm ischemia.
• A maximum of 30 minutes of warm ischemia may be acceptable for lung procurement from non-heart-beating donors.