Long-term preservation with interim evaluation of lungs from a non-heart-beating donor after a warm ischemic interval of 90 minutes - Discussion

摘要: Lung transplantation, like other forms of solid organ is limited by the number good donor organs. It estimated that fewer than 25% all available multiorgan donors have lungs suitable for transplantation.1 There a growing interest in increasing potential pool turning to alternative sources such as use marginal donors,2 lobar or split transplants,3 living-related donors,4 organs from circulation-arrested so called non-heart-beating (NHBDs).5 Many groups6–12 now reported data supporting hypothesis formulated 1991 Egan et al (Chapel Hill, NC)5 transplantation NHBD might be an interesting strategy resolve problem shortage. Also, our laboratory we been interested many years exploring possibility using these donors. In previous rabbit studies, investigated effect postmortem cadaver lung inflation, ventilation, and cooling13–16 on catabolism adenine nucleotides,17,18 pulmonary cell viability,15 graft function.19 In NHBD, period tolerable warm ischemia following cardiac arrest 1 hour.5,7,9,19 After this period, should protected against (further) tissue degradation extend time interval necessary obtain family consent donation organize retrieval. Different opinions exist regarding ideal technique protect ischemic lungs. Some groups13,14,20–22 are convinced ventilation inflation preferred method protection. Others believe topical cooling inside best preserve viability.8,23 We recently demonstrated more effective damage after initial 1-hour interval.24 further study, shown may safely extended up 7 hours postmortem, thereby creating sufficient retrieval (Rega F, Neyrinck A, Verleden G, How long can donor? Presented at 39th Annual Meeting Society Thoracic Surgeons, January 29–February 2, San Diego, CA). In uncontrolled NHBDs (category I, death arrival; category II, failed resuscitation),25 it impossible evaluate quality prior death. To accept only those with adequate function, pretransplant assessment mandatory order not jeopardize life recipient. developed ex vivo evaluation model based own experience isolated reperfusion lungs19 Steen (Lund, Sweden). His group performed described first clinical case successful single NHBD26 65 minutes. In animal value situ preservation, including 90 minutes 150 followed long-term cold storage 24 hours.