C.M.V. Hottenrott, J.E. van Zanden, R. Rebolledo, D. Hoeksma, J. Bubberman, J. Burgerhof, A. Breedijk, B. Yard, M.E. Erasmus, H.G.D. Leuvenink
Chair(s): prof. dr. Eelco de Koning, LUMC
Thursday 10 march 2016
13:00 - 13:30h at Foyer
Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)
Despite the fact that brain death (BD) negatively affects graft quality and transplantation outcome, brain-dead donors remain the major source for transplantation. This study is designed to test if fast or gradual increase in intracranial pressure, ultimately leading to brain death, differentially affects quality of donor lungs. Fisher rats were randomly assigned into three donor groups: 1) ventilated animals, no other interventions and immediately sacrificed, 2) fast - and 3) gradual BD induction. For the latter two modalities animals were sacrificed at 30 minutes, 1 hour, 2 hrs. and 4 hrs. after BD induction. BD animals were hemodynamically stabilized (MAP > 80 mmHg) by HAES/noradrenaline and ventilated with a VT = 6.5 ml/kg of body weight and a PEEP of 3 cmH2O. Hemodynamics and pulmonary inspiratory pressure were monitored. Lungs (n = 8/ group; excluding lost animals n = 6) were analyzed with a histological scoring system and for pro-inflammatory changes in gene expression with RTD-PCR. During slow induction severe hypotension occurred in contrast to severe hypertension during fast BD induction. After BD induction MAP was maintained above the target value however in the fast model higher inotropic support was required. In both groups patho-histological changes were found, albeit that parenchyma injury was more pronounced in the fast model. No difference in the expression of proinflammatory genes was observed between both models. The results of this study suggest that the time course of intracranial pressure increase leading to BD is critical for the quality of the potential donor lungs.