Ex Vivo Lung Evaluation of Prearrest Heparinization in Donation After Cardiac Death


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Abstract

Objective:To evaluate the effects of prearrest heparin administration on lung quality in a model of donation after cardiac death (DCD), and to assess the potential application of ex vivo lung perfusion (EVLP) in the identification of better grafts from the DCD donor pool.Methods:Cardiac death was induced by electric shock in 10 pigs. One group received a prearrest heparin dose of 300 units/kg (H group, n = 5) and the other did not (NH group, n = 5). Animals remained at room temperature for 1 hour without ventilation, defining the warm ischemic time. After harvest, the lungs underwent 6 hours of cold ischemia before being evaluated with EVLP for 4 hours.Results:Static compliance 28 ± 3 versus 29 ± 2 (Cstat—cm H2O), pulmonary vascular resistance (PVR) 593 ± 127 versus 495 ± 70 (PVR—dyn·s/cm5), and oxygenation 327 ± 32 versus 330 ± 28 (ΔPO2—mm Hg) remained stable from the beginning until the end of EVLP in the H group. In the NH group, Cstat started to decline after the first hour (25 ± 2 vs 21 ± 2), ΔPO2 after hour 2 (265 ± 44 vs 207 ± 44), and PVR started to increase after hour 3 (765 ± 132 vs 916 ± 168). Significant differences between the groups were observed at the end of EVLP (P < 0.001). Parameters of lung quality after EVLP also showed significant differences between the groups: wet weight-to-dry weight ratio (P < 0.001), protein in the bronchial lavage (P < 0.01), Na+ + K+-ATPase activity (P < 0.001), and E-selectin (P < 0.001) in the perfusate.Conclusions:Prearrest heparin administration improved organ function by preserving endothelial homeostasis. EVLP proved to be a useful platform for assessing DCD lungs, providing reliable means of discriminating injured grafts.

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