Verbesserung der Transplantatfunktion von NHBD-Lungen durch die Gabe von Glyceroltrinitrat

Abstract

Background: The warm ischemic period of non-heart beating donor (NHBD) lungs results in an increased ischemia reperfusion injury after transplantation potentially deteriorating pulmonary graft function. The purpose of this study was to improve the pulmonary graft function by administering a NO-donor (glyceroltrinitrate, GTN) after reperfusion. Methods: 18 native-bred pigs (bodyweight 20 – 30 kg) underwent left lung allotransplantation. In the control group, lungs were flushed (Perfadex^®) and harvested immediately after cardiac arrest. In the NHBD group (n = 6) and NHBD/GTN group (n = 6) lungs were subjected to a warm ischemia of 90 min before flushing and harvesting. Recipient animals in the NHBD/GTN group received 2 μg/kg/min glyceroltrinitrate intravenously.

After a total ischemic time of 19 hours pulmonary grafts were reperfused and graft function was assessed during an observation period of 5 hours.

Tissue specimens for histological examination were taken at the end of reperfusion. Results: Compared to the control group, pulmonary gas exchange was significantly impaired in the NHBD group. Pulmonary graft function in the NHBD/GTN group showed no differences as compared to the control group and was significantly better than in the NHBD group. Histologic alterations were more pronounced in the NHBD group and NHBD/GTN group as compared to control group. Conclusion: Continuous infusion of glyceroltrinitrate improves pulmonary graft function of NHBD lungs after long-term preservation. NHBD lungs potentially alleviate critical organ shortage in lung transplantation.