A Experimental Study for Pulmonary Transplantation from Non-heart-beating Donor.

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Lung Transplantation has become a feasible option for patients with end-stage lung disease in western countries. Although ther are many patients, the number of lung transplants performed is limited, due to the lack of suitable donors. To increase the number of potential donors, some experimental studies of lung transplantation using arrested heart donors have been performed. In Japan, no transplantation from brain-dead donor is carried out yet, because of the lack of citizn agreement for brain-death. This time, we investigate the possibility of cadaver lung transplantation in clinic using canine left-lung transplantation model. And several inventions and improvements were evaluated for obtaining a stable post-transplant pulmonary functions form cadaver donor.(Experiment 1) Whole-body cooling after circulatory arrest may prevents the donor lung from warm ischemic injury. We evaluated the effect of whole-body cooling by immersing the donor canine in 4C cold water after circulatory arrest … More on the post-transplant pulmonary functions. Comparing the 4-hour whole-body cooling to 4-hour room temperature warm ischemia, there was no significant differences about post-transplant functions.(Experiment 2) From the results of experiment 1, we speculate that this was due to intra-vascular pulmonary thrombi formation after cessation of circulation, and the administration of high-dose urokinase or recombinant tissue-type plasminogen activator (rt-PA) to the cadaver lungs might decompose the fibrin inside the pulmonary capillary bed prior to or during preservation and result in superior pulmonary function in recipients. Using the same canine left lung transplantation model, the effect of administration of urokinase or rt-PA was evaluated. 120000IU of urokinase injection just prior to the donor lung flushing or 5 gamma of rt-PA continuous infusion to the recipient just after reperfusion improved the post-transplant pulmonary function and hemodynamics with even 4-hour cadaver donor lungs.We think 4-hour is enough time to prepare the lung transplantation procedure in clinic. And these results show there is no reason not to carry out cadaver lung transplantation in Japan. Less