Experimental Study on Microthrombi Formation for Lung Transplantation from Non-Heart-Beating Donor

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Background: We previously reported that postmortem heparinization by closed-chest cardiac massage is beneficial in lung transplantation from non-heart-beating donors by preventing microthrombi formation. In this study, we evaluated the optimal time for postmortem heparinization in canine lung transplantation from non-heart-beating donors. We also evaluated the effects of most-mortem administration of urokinase.Methods: Left lung transplantation was performed in 37 weight-matched pairs of mongrel dogs. Donors were sacrificed with an intravenous injection of potassium chloride and left at room temperature for 2 hours. The cadaver donors were assigned randomly to one of the 5 groups according to the timing of post-mortem heparinization. Heparin sodium (1,000U/kg) was given intravenously followed by closed-chest cardiac massage for 2 minutes. After 2 hours of cardiac arrest, donor lungs were flushed with low potassium dextran glucose solution and preserved for 60 minutes. Following left lung allotransplantation, the right pulmonary artery was ligated, and recipient animals were followed up for 3 hours. We also gave 240,000 Unit of urokinase after 60 min of cardiac arrest following heparinization.Results: After transplantation, gas exchange was significantly worse when warm ischemic time exceeded 30 minutes. Administration of urokinase significantly improved pulmonary function.Conclusions: The optimal time for postmortem heparinization in lung transplantation from non-heart beating donors is in the vicinity of 30 minutes after cardiac arrest. Postmortem administration of urokinase along with heparin is beneficial in lung transplantation from non-heart-beating donors by fibrinolytic action on already formed pulmonary microthrombi in the cadaver donor lungs.