Lung transplantation: Donor lung preservation
- Marcelo Cypel, MD, MSc
Marcelo Cypel, MD, MSc
- Assistant Professor, Division of Thoracic Surgery
- University of Toronto
- Tom Waddell, MD, MSc, PhD, FRCS, FACS
Tom Waddell, MD, MSc, PhD, FRCS, FACS
- Professor, Division of Thoracic Surgery
- University of Toronto
- Shaf Keshavjee, MD, MSc, FRCSC, FACS
Shaf Keshavjee, MD, MSc, FRCSC, FACS
- Professor, Division of Thoracic Surgery
- University of Toronto
Donor lung preservation refers to the process of maintaining and protecting a donor lung from the time of lung procurement up until implantation in the recipient. Many factors such as temperature, perfusion volume and pressure, oxygenation, and degree of inflation may impact the likelihood of lung injury during storage or at the time of reperfusion, and also the function of the lung after transplantation.
Much of the experimental work in lung transplantation over the past decade has focused on optimizing methods of lung preservation to reduce the impact of ischemia-reperfusion injury on post-transplant lung function.
The preservation of donor lungs for lung transplantation will be reviewed here. An overview of lung transplantation and discussions of donor evaluation and management, the lung transplantation procedure, early postoperative care, and primary graft dysfunction are provided separately. (See "Lung transplantation: An overview" and "Lung transplantation: Deceased donor evaluation and management" and "Lung transplantation: Procedure and postoperative management" and "Primary lung graft dysfunction".)
DONOR LUNG PROCUREMENT
The donor lung procurement operation is coordinated with cardiac procurement, such that the lungs and the heart may routinely be used for separate recipients (table 1) . Key goals include preventing in situ thrombosis and vasospasm and stabilizing the lung for static cold storage. Lung donation after brain death or cardiac death is discussed separately. (See "Lung transplantation: Deceased donor evaluation and management", section on 'Donation after brain death' and "Lung transplantation: Deceased donor evaluation and management", section on 'Donation after cardiac death'.)
Donation after brain death — The lung procurement operation is usually performed through a median sternotomy [1,2]. In sequence, the pulmonary arteries are dissected free from the ascending aorta and the superior vena cava is dissected free up to the innominate bifurcation. After the heart and lungs are exposed, the donor is anticoagulated with intravenous heparin (300 units per kg). A perfusion cannula is placed in the pulmonary artery at least 1.5 cm distal to the pulmonary valve. A cardioplegia catheter is placed in the ascending aorta. (See "Diagnosis of brain death".)
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- DONOR LUNG PROCUREMENT
- Donation after brain death
- Donation after cardiac death
- STEPS TO OPTIMIZE LUNG PRESERVATION
- Preservation solution
- Pharmacologic additives
- - Prostaglandins
- - Methylprednisolone
- Temperature of preservation solution
- Anterograde and retrograde flush
- Volume of preservation solution
- Pressure of preservation solution infusion
- Lung inflation
- Storage temperature
- Ischemic time
- DONOR AND RECIPIENT SIZE MATCHING
- NEW APPROACHES TO ORGAN PRESERVATION
- Experimental pharmacologic agents
- Normothermic ex vivo perfusion
- SUMMARY AND RECOMMENDATIONS