Rat donor lung quality deteriorates more after fast than slow brain death induction.

Judith E Van Zanden,Henri G D Leuvenink,Michiel E Erasmus,Johannes G Burgerhof,Jeske M Bubberman,Benito A Yard,Rolando A Rebolledo,Annette Breedijk,Maximilia C Hottenrott,Dane Hoeksma,Frank Jmf Dor

doi:10.1371/journal.pone.0242827

Judith E Van Zanden, Henri G D Leuvenink + Show 9 more

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https://doi.org/10.1371/journal.pone.0242827

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Abstract

Donor brain death (BD) is initiated by an increase in intracranial pressure (ICP), which subsequently damages the donor lung. In this study, we investigated whether the speed of ICP increase affects quality of donor lungs, in a rat model for fast versus slow BD induction. Rats were assigned to 3 groups: 1) control, 2) fast BD induction (ICP increase over 1 min) or 3) slow BD induction (ICP increase over 30 min). BD was induced by epidural inflation of a balloon catheter. Brain-dead rats were sacrificed after 0.5 hours, 1 hour, 2 hours and 4 hours to study time-dependent changes. Hemodynamic stability, histological lung injury and inflammatory status were investigated. We found that fast BD induction compromised hemodynamic stability of rats more than slow BD induction, reflected by higher mean arterial pressures during the BD induction period and an increased need for hemodynamic support during the BD stabilization phase. Furthermore, fast BD induction increased histological lung injury scores and gene expression levels of TNF-α and MCP-1 at 0.5 hours after induction. Yet after donor stabilization, inflammatory status was comparable between the two BD models. This study demonstrates fast BD induction deteriorates quality of donor lungs more on a histological level than slow BD induction.

Highlights

Lung transplantations are generally performed with lungs derived from brain-dead donors, who suffered from extensive central nervous system injury secondary to trauma, hemorrhage or infarction [1, 2]
We showed that fast brain death (BD) induction deteriorates quality of donor lungs more on a histological level than slow BD induction
Rats were randomly assigned to 3 donor groups, (Fig 1): 1) control, 2) fast BD induction (ICP increase over 1 min, n = 32) or 3) slow BD induction (ICP increase over 30 min, n = 32)

Summary

Introduction

Lung transplantations are generally performed with lungs derived from brain-dead donors, who suffered from extensive central nervous system injury secondary to trauma, hemorrhage or infarction [1, 2]. An interesting observation in lung donation is the lower procurement rate compared to other solid organs, with an acceptance rate of 56% for lungs in contrast to 76% for livers and 82% for kidneys [3, 4]. Besides multiple risk factors for donor lung injury such as mechanical ventilation, aspiration and infection, the process of brain death (BD) is described to induce lung damage [5,6,7].

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