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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 73-82, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
S Schueler, PA De Valeria, M Hatanaka, DE Cameron, K Bando, M Zeebley, GM Hutchins, BA Reitz and WA Baumgartner
Donor core cooling with cardiopulmonary bypass is a valid method of
clinical lung preservation. However, organ ischemia with this method is
still limited to short-term intervals. Since circulating leukocytes
participate in postischemic injury through the release of oxygen- derived
free radicals, we examined whether leukocyte depletion by mechanical
filtration could extend ischemic tolerance of the lung during preservation
and subsequent double lung transplantation. Bovine donor lungs were
preserved by donor core cooling (10 degrees to 15 degrees C) with
cardiopulmonary bypass. Donor lungs were removed, stored in 4 degrees C
donor blood for 24 hours, and transplanted. Graft function was studied for
6 hours after transplantation. Group 1 animals (n = 6) underwent standard
cardiopulmonary bypass with whole blood for donor and recipient procedures.
In group 2 (n = 6), leukocyte filters were incorporated into the
cardiopulmonary bypass circuit in both donor and recipient operations. In
group 2 recipient animals leukocyte counts decreased to 3% of mean baseline
values and remained low during the experiment. Postischemic lung function
(assessed by systemic arterial oxygenation, pulmonary artery pressure,
pulmonary vascular resistance, airway pressure, lung water content, and
end-point histologic characteristics) was significantly better preserved in
the animals with leukocyte depletion. Leukocyte depletion by mechanical
filtration in both donor and recipient improves the ischemic tolerance of
the lung beyond that provided by donor core cooling alone, resulting in
excellent lung function after 24 hours of ischemia.
ARTICLES
Successful twenty-four-hour lung preservation with donor core cooling and leukocyte depletion in an orthotopic double lung transplantation model
Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Md 21205.
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