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Nitric oxide during perfusion improves posttransplantation function of non-heart-beating donor lungs

Lookup NU author(s): Dr Doug Aitchison, Hannah Orr, Emeritus Professor Paul Flecknell, Professor John Kirby, Professor John Dark

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Abstract

Background. We attempted to determine in a pig model whether 20 ppm of nitric oxide (NO) during perfusion ameliorates warm ischemic lung injury in the non-heart-beating donor (NHBD), thereby improving function with longer warm ischemia. Methods. Lungs were retrieved from three groups (n=6): 1 hr (NHBD1) and 2 hr with and without NO (NHBD2NO, NHBD2) after hypoxic death. For assessment and preservation, left lungs were ventilated with 100% oxygen (NHBD2NO with added NO) and perfused for 20 min with neutrophil-depleted, deoxygenated blood in Perfadex solution. Pulmonary vascular and airway pressures and blood flow were measured with pulmonary venous blood gases. Perfusion temperature was reduced to 18°C prior to storage at 4°C before transplantation. Results. NO during perfusion significantly improved posttransplantation pulmonary venous oxygenation (NHBD1 [mean ± SD] 51±14 kPa, NHBD2 54±16 kPa, and NHBD2NO 61±6 kPa; P=0.01) and airway pressures (NHBD1 30.8±3.5, NHBD2 32.5±5.6, NHDB2NO 29.4±5.3; P=0.0001). NO significantly improved pulmonary vascular resistance (excluding the initial cold-induced vasoconstricted reperfusion period): NHBD1 19±9 Wood units, NHBD2 28±25 Wood units, NHDB2NO 16±10 Wood units, P=0.029. Neutrophil uptake was significantly lowered by NO: NHBD1 0.6±1.4 *109 minute-1, NHBD2 1.2±1.0*109 minute-1, NHBD2NO 0.4±0.9*109 minute-1 (P=0.029). Conclusions. This technique satisfactorily assesses and preserves the non-heart-beating lung. NO during preservation reverses the slight deterioration seen when increasing warm ischemia from 1 to 2 hr, significantly improving transplant oxygenation, vascular resistance, and airway pressures. This may be a result of the observed significant reduction in neutrophil sequestration.


Publication metadata

Author(s): Aitchison JD, Orr HE, Flecknell PA, Kirby JA, Dark JH

Publication type: Article

Publication status: Published

Journal: Transplantation

Year: 2003

Volume: 75

Issue: 12

Pages: 1960-1964

ISSN (print): 0041-1337

ISSN (electronic): 1534-6080

Publisher: Lippincott Williams & Wilkins

URL: http://dx.doi.org/10.1097/01.TP.0000067528.58552.34

DOI: 10.1097/01.TP.0000067528.58552.34

PubMed id: 12829894


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