In situ lung perfusion is a valuable tool to assess lungs from donation after circulatory death donors category I–II

Donations after circulatory death (DCD) lung grafts are an alternative to extend the donor pool in lung transplantation. This study investigates the use of an in situ lung perfusion system (ISLP) in the donor to evaluate category III lungs. Pigs were sacrificed by ventricular fibrillation. All animals underwent 20min of cardiopulmonary resuscitation and 5min hands-off period after which heparin was administered. In group [WI-1], this was followed by 1h of warm ischemia (WI) and 2h of topical cooling (TC). In group [WI-2], 2h of WI was followed by 1h of TC. In group [WI-0], there was a minimal period of WI and no TC. In all three groups, the lungs were then evaluated during 60min with ISLP. [WI-0] lungs showed a significantly higher compliance and PO2/FiO2 compared with [WI-1] and [WI-2]. PaCO2 and lactate production were higher in [WI-2] versus [WI-0]. Wet/Dry weight ratio was significantly higher in [WI-2] compared with [WI-0] in two lung biopsy locations. A high W/D weight ratio was correlated with a lower compliance, higher lactate production, and a higher PaCO2. ISLP is an effective way to assess the quality of lungs from category III DCD donors.