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PubMed1998

The lung scan in patient selection for lung volume reduction surgery.

UNLABELLED: The lung scan is one of the most important diagnostic tests used for selecting candidates for lung volume reduction surgery (LVRS) and for determining the actual percentage of lung to be resected during the surgery (McKenna R, personal communication, 1997). This article describes the anatomical quantitation of the lungs. METHODS: We used automatic and manual regions of interest in the posterior, and both posterior obliques of lung perfusion images to calculate the percent function in each individual lung lobe. RESULTS: We evaluated 172 patients with this technique. Subsequently 136 of these patients had LVRS. CONCLUSION: The anatomical placement of regions of interest in the lung perfusion image aids the thoracic surgeon in selecting LVRS candidates and in determining the amount of lung to be resected during surgery.

Aged↗
PubMed1998

[Lung collapse during one lung ventilation does not change low frequency respiratory mechanics].

The present study was carried out to clarify the effects of lung collapse for one lung ventilation on respiratory system impedance during thoracic surgery. We measured the impedances of respiratory system (RS) in eight paralyzed subjects under anesthesia employing a pseudorandom noise forced volume oscillation technique. These measurements were performed before and after the one lung ventilation. The impedance values were fitted to a mathematical model consisting of a single conduit connected with a viscoelastic parenchyma. Lung collapse did not affect resistance and reactance in RS after the re-expansion. The mathematical modeling showed no significant effect of one lung ventilation on all the parameters of airway and parenchyma. There was no difference in model fit of the parameters, indicated by the presence of the goodness-of-fit parameter (chi 2), before and after lung collapse. In conclusion, lung collapse during one lung ventilation does not change low frequency respiratory mechanics.

Aged↗
PubMed1996

Transthoracic bioimpedance can measure extravascular lung water in acute lung injury.

We used a porcine endotoxemic model of acute lung injury to compare extravascular lung water (EVLW) measured by right transthoracic bioimpedance to postmortem gravimetric EVLW measurements. Adult pigs were randomized into control (N = 5) or endotoxin groups [150 microgram/kg Escherichia coli lipopolysaccharide B for 1 hr followed by 3 hr of resuscitation for a thermodilution cardiac output less than 90% of baseline using either isotonic saline (N = 5) or isooncotic albumin (N = 5)]. Right lung resistance was measured using a novel electrode array and a highly sensitive analyzer and was used to calculate right lung resistivity. At the end of the experiment, animals in the endotoxin-albumin group had higher gravimetric EVLWs than those in the endotoxin-saline or control groups (P < 0.05). Right lung resistivity corrected for body weight significantly correlated with gravimetric EVLW (r2 = 0.49; SEE = 0.96; P = 0.0038). Using multiple regression analysis, a predictive equation for EVLW based on right lung resistivity, body weight, and mean pulmonary artery pressure was generated (r2 = 0.81; SEE = 0.60; P < 0.0001). These results demonstrate that right lung resistivity measurements can provide a noninvasive estimate of EVLW. In addition, crystalloid may be preferable to colloid for fluid resuscitation in noncardiogenic pulmonary edema.

Animals↗
PubMed1983

Importance of anti-lung antibody in farmer's lung disease.

The presence of anti-lung antibody was evaluated in 20 patients with farmer's lung disease. Antibody was found in 14. In patients with disease of less than five years' duration, there was no evidence of any significant differences in vital capacity, total lung capacity, diffusion capacity, and PaO2 between those with and without anti-lung antibody. However, in patients with disease of longer than five years' duration, the diffusion capacity was lower in the anti-lung antibody-positive group (p less than 0.05). The prevalence of abnormalities of vital capacity and diffusion capacity and fibrosis on chest roentgenograms was higher in those who had anti-lung antibody and disease of more than five years' duration. The study suggests that anti-lung antibody is present before permanent measurable physiologic abnormality occurs and may potentiate the pulmonary damage during subsequent episodes.

Adult↗
PubMed1985

Cutaneous thermal burn and oxidant-mediated acute lung injury: appearance in serum of lung-related LDH isoenzyme.

Previous studies from our laboratory have demonstrated that thermal injury to the skin of rats is associated with the production of oxygen radicals by complement-activated blood neutrophils, resulting in acute lung injury as demonstrated by increases in lung vascular permeability and morphological evidence of vascular endothelial cell damage, interstitial edema, and alveolar hemorrhage. In the present study, the analysis of sera from thermally injured rats reveals an isoenzyme profile for lactate dehydrogenase (LDH;EC 1.1.1.27) that is compatible with origin from lung. The appearance of LDH-4 isoenzyme in serum of thermally injured rats correlates linearly with indices of lung damage, supporting the results of previous studies suggesting that thermal trauma to the skin can cause oxygen radical production by complement-activated blood neutrophils with resultant acute microvascular injury in the lung interstitium. Furthermore, interventions that protect from oxidant-mediated lung injury (catalase, scavengers of hydroxyl radical, iron chelators or neutrophil depletion) result in significant reductions in serum levels of the LDH-4 isoenzyme following thermal injury to the skin. Thus, measurements of LDH isoenzyme patterns in serum appear to be useful in monitoring tissue damage such as oxygen radical-mediated acute lung injury.

Animals↗
PubMed2004

Use of quantitative lung scintigraphy to predict postoperative pulmonary function in lung cancer patients undergoing lobectomy.

BACKGROUND: In patients with non-small cell lung cancer, the only realistic chance of cure is surgical resection. However, in some of these patients there is such poor respiratory reserve that surgery can result in an unacceptable quality of life. In order to identify these patients, various pulmonary function tests and scintigraphic techniques have been used. The current American College of Physicians and British Thoracic Society guidelines do not recommend the use of quantitative ventilation-perfusion scintigraphy to predict postoperative function in lung cancer patients undergoing lobectomy. These guidelines may have been influenced by previous scintigraphic studies performed over a decade ago. Since then there have been advances in both surgical techniques and scintigraphic techniques, and the surgical population has become older and more female represented. METHODS: We prospectively performed spirometry and quantitative ventilation-perfusion scintigraphy on 61 consecutive patients undergoing lobectomy for lung cancer. Spirometry was repeated one-month postsurgery. Both a simple segment counting technique alone and scintigraphy were used to predict the postoperative lung function. RESULTS: There was statistically significant correlation (p < 0.01) between the predicted postoperative lung function using both the simple segment counting technique and the scintigraphic techniques. However, the correlation using simple segment counting was of negligible difference compared to scintigraphy. CONCLUSIONS: In keeping with current American Chest Physician and British Thoracic Society guidelines, our results suggest that quantitative ventilation-perfusion scintigraphy is not necessary in the preoperative assessment of lung cancer patients undergoing lobectomy. The simple segmenting technique can be used to predict postoperative lung function in lobectomy patients.

Aged↗
PubMed2004

Dose and volume reduction for normal lung using intensity-modulated radiotherapy for advanced-stage non-small-cell lung cancer.

PURPOSE: To investigate dosimetric improvements with respect to tumor-dose conformity and normal tissue sparing using intensity-modulated radiotherapy (IMRT) compared with three-dimensional conformal radiotherapy (3D-CRT) for advanced-stage non-small-cell lung cancer (NSCLC). METHODS AND MATERIALS: Forty-one patients with Stage III-IV and recurrent NSCLC who previously underwent 3D-CRT were included. IMRT plans were designed to deliver 63 Gy to 95% of the planning target volume using nine equidistant coplanar 6-MV beams. Inverse planning was performed to minimize the volumes of normal lung, heart, esophagus, and spinal cord irradiated above their tolerance doses. Dose distributions and dosimetric indexes for the tumors and critical structures in both plans were computed and compared. RESULTS: Using IMRT, the median absolute reduction in the percentage of lung volume irradiated to >10 and >20 Gy was 7% and 10%, respectively. This corresponded to a decrease of >2 Gy in the total lung mean dose and of 10% in the risk of radiation pneumonitis. The volumes of the heart and esophagus irradiated to >40-50 Gy and normal thoracic tissue volume irradiated to >10-40 Gy were reduced using the IMRT plans. A marginal increase occurred in the spinal cord maximal dose and lung volume >5 Gy in the IMRT plans, which could be have resulted from the significant increase in monitor units and thus leakage dose in IMRT. CONCLUSION: IMRT planning significantly improved target coverage and reduced the volume of normal lung irradiated above low doses. The spread of low doses to normal tissues can be controlled in IMRT with appropriately selected planning parameters. The dosimetric benefits of IMRT for advanced-stage non-small-cell lung cancer must be evaluated further in clinical trials.

Adult↗
PubMed2002

Does lung biopsy help patients with interstitial lung disease?

OBJECTIVES: The decision to perform lung biopsy in the evaluation of interstitial lung disease (ILD) is based on the probability that this examination will yield a specific diagnosis, leading to a change in treatment. The purpose of this study was to identify factors that influence the diagnostic yield of lung biopsy for ILD. METHODS: One hundred patients underwent lung biopsy for ILD over a 5-year period. There were 59 men and 41 women; with a median age of 51.5 years. Thirty percent underwent open lung biopsy, while 70% had videothoracoscopic biopsy. Patient and disease characteristics, prior diagnostic studies, pre-operative therapy, biopsy type, site, size, number, and laterality were compared to identify factors that might influence diagnostic yield. RESULTS: Forty-two percent had a specific diagnosis, while 58% had a non-specific diagnosis. Right side was selected in 57.1% of patients with a specific diagnosis and 48.3% of patients without a specific diagnosis (P=0.381). Right lower lobe was the main site for biopsy in the specific diagnosis group compared to the non-specific group (35.7 versus 20.7%, P=0.095). Left upper lobe was the main site for biopsy in the non-specific diagnosis group compared to the specific diagnosis group (41.4 versus 23.8%, P=0.067). Mean volume of biopsy was 12.3 cm(3) in the specific diagnosis group and 12 cm(3) in the non-specific diagnosis group (P=0.373). Two or more biopsies were carried out in 38.1% of the specific diagnosis group compared to 25.9% of the non-specific diagnosis group (P=0.192). There were no significant factors in predicting a diagnostic yield. Of those patients with a specific diagnosis, 59.5% had therapy altered, compared to 55.2% of those with a non-specific diagnosis (P=0.664). CONCLUSIONS: Lung biopsy does not always provide a specific diagnosis and does not always change therapy. The site, size, number, and laterality of the biopsy specimen have no definite influence on diagnosis. There is a trend to improve diagnostic yield by carrying out two or more biopsies on the right lung.

Adrenal Cortex Hormones↗
PubMed2001

Cytological monitoring of peripheral blood, bronchoalveolar lavage fluid, and transbronchial biopsy specimens during acute rejection and cytomegalovirus infection in lung and heart--lung allograft recipients.

STUDY OBJECTIVES: Acute rejection and cytomegalovirus (CMV) infection are important complications after lung and heart--lung transplantation. We sought to investigate whether acute rejection and CMV infection demonstrated as CMV antigenemia had an effect on the cell profiles of peripheral blood (PB), bronchoalveolar lavage fluid (BAL-F), or TBB histology. PATIENTS AND DESIGN: In this prospective study, composition of cells in PB, BAL-F, and TBB samples from 20 lung or heart-lung transplantation patients were analyzed during episodes of acute rejection or CMV antigenemia. Rejection was graded according to the International Society for Heart and Lung Transplantation criteria. As controls, samples with no evidence of rejection or infection were used. To evaluate the effect of time on cellular findings, samples were divided into three groups according to time after transplantation: 1--30, 31--180, and more than 180 d after transplantation. RESULTS: Acute rejection was associated with mild blood basophilia (p<0.05; specificity 94%, sensitivity 42%). In BAL-F during rejection, the number of basophils (p<0.05), eosinophils (p<0.05), and lymphocytes (p<0.05; specificity 77%, sensitivity 64%) was increased compared to controls during the post-operative month 1. Later-occurring rejections were associated with increased amounts of neutrophils in BAL-F (p<0.05; specificity 82%, sensitivity 74%). In TBB histology, acute rejections were associated with perivascular and/or peribronchial infiltration of lymphocytes (p<0.001) and plasma cells (p<0.05) compared to controls. In our patients receiving gancyclovir prophylaxis, CMV antigenemia did not significantly alter the cell profiles in PB and BAL-F nor the inflammatory cell picture in TBB histology. CONCLUSION: TBB histology remains the 'gold standard' for diagnosing rejection in lung and heart-lung transplantation patients, as the inflammatory cell findings in TBB specimens are highly specific for rejection. The cellular changes associated with rejection, mild PB basophilia and increased proportions of lymphocytes in early- and neutrophils in later-occurring rejection, observed in BAL-F cannot be considered specific for rejection, but may warrant clinical suspicion of rejection.

Acute Disease↗
PubMed2002

Effects of lung recruitment maneuver and positive end-expiratory pressure on lung volume, respiratory mechanics and alveolar gas mixing in patients ventilated after cardiac surgery.

BACKGROUND: It is unclear whether positive end-expiratory pressure (PEEP) is needed to maintain the improved oxygenation and lung volume achieved after a lung recruitment maneuver in patients ventilated after cardiac surgery performed in the cardiopulmonary bypass (CPB). METHODS: A prospective, randomized, controlled study in a university hospital intensive care unit. Sixteen patients who had undergone cardiac surgery in CPB were studied during the recovery phase while still being mechanically ventilated with an inspired fraction of oxygen (FiO2) 1.0. Eight patients were randomized to lung recruitment (two 20-s inflations to 45 cmH2O), after which PEEP was set and kept for 2.5 h at 1 cmH2O above the pressure at the lower inflexion point (14+/-3 cmH2O, mean +/-SD) obtained from a static pressure-volume (PV) curve (PEEP group). The remaining eight patients were randomized to a recruitment maneuver only (ZEEP group). End-expiratory lung volume (EELV), series dead space, ventilation homogeneity, hemodynamics and PaO2 (oxygenation) were measured every 30 min during a 3-h period. PV curves were obtained at baseline, after 2.5 h, and in the PEEP group at 3 h. RESULTS: In the ZEEP group all measures were unchanged. In the PEEP group the EELV increased with 1220+/-254 ml (P<0.001) and PaO2 with 16+/-16 kPa (P<0.05) after lung recruitment. When PEEP was discontinued EELV decreased but PaO2 was maintained. The PV curve at 2.5 h coincided with the curve obtained at 3 h, and both curves were both steeper than and located above the baseline curve. CONCLUSIONS: Positive end-expiratory pressure is required after a lung recruitment maneuver in patients ventilated with high FiO2 after cardiac surgery to maintain lung volumes and the improved oxygenation.

Aged↗
PubMed2000

Simultaneous quantitation of topoisomerase II alpha and beta isoform mRNAs in lung tumor cells and normal and malignant lung tissue.

Certain drugs used in the treatment of lung cancer and other human malignancies are cytotoxic because of their ability to interact with the two isoforms of topoisomerase II (topo II), topo IIalpha and topo IIbeta. As part of an effort to evaluate the contribution of topo II alterations to drug sensitivity and resistance in lung cancer, we have developed a semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) assay to measure levels of topo II alpha and beta mRNAs simultaneously using a single pair of primers with sequences common to both isoforms. The PCR products derived from the topo II alpha and beta mRNAs are both 446 bp but have different electrophoretic mobilities in a nondenaturing polyacrylamide gel, allowing sensitive, rapid quantitation when the products are radiolabeled with [35S]-dATP. Using this RT-PCR method, poly(A+) RNA from 13 non-small cell lung cancer (NSCLC) cell lines was analyzed. The results obtained indicated that the cell lines express a wide range of topo II alpha mRNA levels (12-fold) and topo IIbeta mRNA levels (5.5-fold). Tumor and normal lung tissues from 25 patients with NSCLC were also examined. In the tumor samples, the levels of the topo II alpha and beta mRNAs were similar. However, mean topo IIalpha mRNA levels in the tumors were approximately 7-fold higher than those of the paired normal lung tissues. In contrast, topo IIbeta mRNA levels were similar in both tumor and normal lung. Topo II alpha and beta mRNA levels were both significantly lower in the squamous cell tumors than in the adenocarcinoma samples. Topo IIbeta mRNA levels in the squamous cell tumors were also significantly lower than those in paired normal lung tissue. The RT-PCR method described is reliable and convenient, and for the first time, makes the rapid simultaneous direct comparison of topo IIalpha and topo IIbeta mRNA levels feasible in large numbers of clinical samples.

Antigens, Neoplasm↗
PubMed2002

Factors influencing the use of thoracic radiotherapy in lung cancer--an analysis of the 1995 Scottish lung cancer audit.

AIMS: To determine the frequency of delivery of thoracic radiotherapy (TRT) to patients with lung cancer in Scotland in 1995, and identify patient, disease and process variables affecting the probability of receiving TRT. METHODS: Retrospective case note audit of all patients with lung cancer diagnosed in Scotland in 1995. RESULTS: 1118 (30.8%) of 3,855 patients diagnosed with lung cancer in Scotland in 1995 for whom the medical records could be traced received TRT. In those who did not have small cell lung cancer, multivariate analysis indicated that diagnosis by a lung cancer specialist, clinical extent of disease and microscopic verification of cancer (all P<0.0001) and age (P=0.0005) were associated with an increased chance of receiving TRT. There was also a wide variation between different Health Boards (HB) of residence in the proportion of patients receiving TRT (P<0.0001). There was no association between the presence of local symptoms (cough, chest pain or haemoptysis) and the delivery of TRT. Of 351 patients with limited stage small cell lung cancer, 51 (14.5%) received chemotherapy and TRT, and 19 (5.4%) chemotherapy and cranial irradiation. CONCLUSIONS: TRT was delivered to fewer than one-third of patients with lung cancer in Scotland in 1995. This is lower than reported in other international audits. The chance of receiving TRT seemed to be associated with service issues rather than clinical need.

Aged↗
PubMedDate not supplied

Extracorporeal membrane oxygenation after lung or heart-lung transplantation.

Extracorporeal membrane oxygenation (ECMO) has proven to be life-saving in cases of reversible lung injury. One potential application of ECMO in the field of lung transplantation is the support of the patient with acute pulmonary failure immediately after transplantation until the transplanted lung has resumed satisfactory gas transfer function. The authors have had experience with ECMO in three patients who have had acute pulmonary failure and inadequate oxygenation after bilateral single lung (BSLT) or heart-lung transplantation (HLT). Patient 1 is a 47-year-old woman with alpha-1 antitrypsin deficiency who underwent a HLT and experienced fulminant pulmonary edema secondary to an intraoperative coagulopathy that required massive transfusion. Patient 2 was a 45-year-old man with a patent ductus arteriosus (PDA) that resulted in Eisenmenger's complex. Patient 2 underwent an HLT and experienced acute pulmonary failure. Patient 3 is a 58-year-old woman with an atrial septal defect (ASD) and pulmonary hypertension who underwent repair of the ASD and BSLT. Patient 3 experienced complete atelectatic collapse of the right lung and pulmonary edema of the left lung. These three patients had PO2 measurements of 23, 39, and 23 mmHg, respectively, despite receiving 100% FiO2 and maximal ventilatory support. All three patients were subsequently placed on ECMO and had improvement of their oxygenation. Patients 1 and 3 were successfully weaned from ECMO and extubated on post-operative day (POD) 21 and 16, respectively. Patient 2 had significant improvement in oxygenation but died on POD 4 of persistent mediastinal hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Loss, Surgical↗
PubMed1992

Whence the lungs? A study to assess suitability of donor lungs for transplantation.

Efforts at clinical lung transplantation have been hampered by an insufficient donor pool. To estimate the number of potential suitable lung donors, we conducted a UNOS-sponsored survey of organ procurement organizations and collected data with respect to possible lung donation from human cardiac donors. Contact with OPOs was made by telephone after cardiac donors were identified by UNOS. Of 150 cardiac donors, 7 were utilized for lung or heart-lung transplantation. By our criteria, however, 47 additional donors had lungs that may have been suitable for transplantation but were not utilized, and frequently were not offered for transplantation for a variety of reasons. This survey implies that approximately 25% of cardiac donors likely have lungs that may be suitable for transplantation.

Adult↗
PubMed2005

Simulation of lung function evolution after heart-lung transplantation using a numerical model.

A morphometry-based computational model for expiratory flow in humans was used to study the unusual configuration of the maximum expiratory flow-volume (MEFV) curve associated with alterations in lung function after heart-lung transplantation (HLT). The postoperative MEFV curve showed a peak, followed by a gently sloping plateau over the midvolume range, ending in a knee where the flow suddenly fell, instead of the usual observed uniform decrease in expiratory flow. We have tested several hypotheses about the relationship between the pattern of changes in the configuration of the MEFV curve and pathological changes in the airway mechanics through computer simulations. Principally, effects of lung denervation and airway obstruction, associated with the development of bronchiolitis obliterans in the lung periphery, have been investigated. The calculated curves are similar in appearance to the measured postoperative flow-volume curves and confirm reliability of the earlier hypotheses. We conclude that the plateau-knee configuration of the MEFV curve can result from flow limitation in one of the first airway generations, that this flow limitation coupled with an increase in peripheral airway resistance results in plateau shortening, and that flows exceeding predicted values during the second part of expiration may be produced by lung denervation. Additionally our results demonstrate that airways larger than the transitional and respiratory bronchioles can be involved in pulmonary function deterioration observed in patients affected with obliterative bronchiolitis. Our findings indicate that the computational model, based on a symmetrical dichotomous branching structure of the bronchial tree, along with pathological data, can be employed to evaluate the effects of heterogeneous changes in the lung periphery. Index Terms-Airway mechanics, forced expiration, lung transplantation, mathematical modeling, maximal expiratory flow-volume curve.

Computer Simulation↗
PubMed2005

Determinants of health utility in lung and heart-lung transplant recipients.

Bronchiolitis obliterans syndrome (BOS) is associated with poor health-related quality of life (HRQL) following lung and heart-lung transplantation, but few other determinants of HRQL have been described. We performed a cross-sectional study of standard gamble utility, a preference-based measure of HRQL, in 90 stable lung and heart-lung transplant recipients. We used bivariate analyses and multiple linear regression to evaluate associations between utility scores and candidate predictor variables including age, sex, indication for transplant (obstructive, interstitial, suppurative and pulmonary vascular diseases), transplant type (bilateral, single and heart-lung), time since transplant, body mass index, arterial PO(2), creatinine clearance, number of medications, presence of BOS and risk-attitude score. The median utility was 0.88 (inter-quartile range: 0.50-0.99). Multivariable analysis showed that female sex, absence of BOS, better renal function and longer time since transplantation were associated with higher utility scores, and that there were utility differences across diagnostic groups. Although BOS is a major determinant of utility following lung and heart-lung transplantation, other demographic and clinical factors are also associated with significant differences in this measure of HRQL.

Adolescent↗
PubMed1994

Lung volumes and expiratory flow limitation during exercise in interstitial lung disease.

Lung volumes were measured at rest and during exercise by an open-circuit N2-washout technique in patients with interstitial lung disease (ILD). Exercise tidal flow-volume (F-V) curves were also compared with maximal F-V curves to investigate whether these patients demonstrated flow limitation. Seven patients underwent 4 min of constant work rate bicycle ergometer exercise at 40, 70, and 90% of their previously determined maximal work rates. End-expiratory lung volume and total lung capacity were measured at rest and near the end of each period of exercise. There was no significant change in end-expiratory lung volume or total lung capacity when resting measurements were compared with measurements at 40, 70, and 90% work rates. During exercise, expiratory flow limitation was evident in four patients who reported stopping exercise because of dyspnea. In the remaining patients who discontinued exercise because of leg fatigue, no flow limitation was evident. In all patients, the mean ratio of maximal minute ventilation to maximal ventilatory capacity (calculated from maximal F-V curves) was 67%. We conclude that lung volumes during exercise do not significantly differ from those at rest in this population and that patients with ILD may demonstrate expiratory flow limitation during exercise. Furthermore, because most patients with ILD are not breathing near their maximal ventilatory capacity at the end of exercise, we suggest that respiratory mechanics are not the primary cause of their exercise limitation.

Airway Obstruction↗
PubMedDate not supplied

Lung retrieval from non-heart-beating donors: first experience with an innovative preservation strategy in a pig lung transplantation model.

OBJECTIVE: Lung transplantation is limited by the scarcity of donor organs. Lung retrieval from non-heart-beating donors (NHBD) might extend the donor pool and has been reported recently. However, no studies in NHBD exist using the novel approach of retrograde preservation with Perfadex solution. METHODS: Heparinized asystolic pigs (n = 5, 30-35 kg) were ventilated for 90 min. The lungs were retrogradely preserved with Perfadex solution and stored inflated at 4 degrees C for 3 h. Left lung transplantation in the recipient was followed by exclusion of the right lung. Results were compared to sham-operated animals. Oxygenation, hemodynamics and dynamic compliance were monitored for 4 h. Infiltration of polymorphonuclear cells (PMNs) and stereological quantification of alveolar edema was performed. Statistical analysis comprised Kruskal-Wallis and Mann-Whitney tests and ANOVA analysis with repeated measures. RESULTS: No mortality was observed. During preservation, continuous elimination of blood clots via the pulmonary artery venting site was observed. Oxygenation and compliance were similar between groups, but sham controls showed significantly lower pulmonary vascular resistance. Stereological quantification revealed higher volume fractions of intra-alveolar edema in NHBD grafts, while PMN infiltration was comparable to sham controls. CONCLUSIONS: Use of NHBD lungs results in excellent outcome after 90 min of warm ischemia followed by retrograde preservation with Perfadex solution. This novel approach can optimize lung preservation by eliminating clots from the pulmonary circulation and might clinically be considered in brain-dead organ donors who become hemodynamically unstable prior to organ harvest. Further trials with longer warm and cold ischemic periods are necessary to further elucidate this promising approach to donor pool expansion.

Animals↗