Objectives: We previously established a reperfusion circuit that allowed safe maintenance of porcine
pulmonary lungs for up to 6hours. Aim of our study was to use this set-up to recondition
lungs damaged by brain-death induction.
Methods: Brain death was induced by rapid balloon inflation into the cranial cavity (BD, n=6)
or not induced (control, n=6). After cold Perfadex perfusion (40ml/kg) heart-lung-block
was explanted, cannulated after 90min warm ischemia and placed in a circuit consisting
of rotary blood-pump, leucocyte-filter, heparin-coated deoxigenator, reservoir and
tubing. Priming consisted of erythrocyte concentrate and Steen-solution (1:1; Hb5,5mg/dl).
Perfusion started at 21°C, temperature increased to 37°C within 30min and continued
for 6hours. Ventilation started at 32°C (FiO2=0,3). Ventilation parameters, gas exchange
and haemodynamics were monitored pre-harvest and hourly during reperfusion, wet-dry
ratios measured pre- and postreperfusion, histology performed on H&E stains.
Results: All lungs were perfused for 6hrs. Control lungs showed no significant change throughout
the study. After 3 hours of brain death there was significant reduction of pulmonary
compliance (35±4,3 vs. 47±2,9ml/cmH2O), increase of PVR (322±73 vs. 193±97dynes),
mild hypercapnia (49±7,2 vs. 41± 7,2mmHg), histologically diffuse interstitial edema
with massive pulmonary cellular infiltration. During first hour of in-vitro reconditioning
functional parameters deteriorated further significantly vs. control (compliance:
22±4,6 vs. 35±7,1ml/cmH2O; PVR 1356±626 vs. 718±176 dynes; p<0,05), however recovered
after further 3–4 hours to control values and remained stable until study-end-point.
Multi-lobar histology proved completely normalized parenchyma.
Conclusion: Reconditioning of predamaged lungs after brain-dead is feasible. After 3 hours of
reperfusion pre-damaged lungs achieved the values of control lungs.
