Post-mortem administration of urokinase in canine lung transplantation from non-heart-beating donors.

Abstract

BACKGROUND:

We previously reported that post-mortem heparinization by closed-chest cardiac massage within 30 minutes after cardiac arrest is beneficial in lung transplantation (LTx) from non-heart-beating donors (NHBDs) by preventing formation of microthrombi. In this study, we evaluated the effects of post-mortem administration of urokinase 60 minutes after cardiac arrest.

METHODS:

Left LTx was performed in 12 pairs of mongrel dogs. Donors were sacrificed and left at room temperature for 2 hours. In Group 1 (n = 6), heparin sodium (1,000 U/kg) was administered intravenously 60 minutes after cardiac arrest, then closed-chest cardiac massage was performed for 1 minute to distribute the heparin. In Group 2 (n = 6), the donors were treated as in Group 1, except, in addition to heparin sodium, urokinase (120,000 U) was administered intravenously before and at the end of cardiac massage. After 2 hours of cardiac arrest, donor lungs were flushed with low-potassium dextran glucose solution. After left LTx, the right pulmonary artery was ligated, and recipients were followed up for 3 hours. Uni- and multivariate repeat analyses were performed to obtain statistical data.

RESULTS:

Group 2 had significantly better arterial oxygen tension, lower pulmonary vascular resistance and lower wet/dry weight ratio of the transplanted lung than Group 1. d-dimer level during the warm ischemia was significantly lower in Group 2 than in Group 1.

CONCLUSIONS:

Post-mortem administration of urokinase along with heparin is beneficial in LTx from NHBDs by fibrinolytic action on already formed pulmonary microthrombi in the cadaver donor lungs.

• Authors: Ryujiro Sugimoto, Hiroshi Date, Seiichiro Sugimoto, Mikio Okazaki, Keiju Aokage, Hidetoshi Inokawa, Motoi Aoe, Yoshifumi Sano
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 25 Issue 9 Pg. 1148-53 (Sep 2006) ISSN: 1557-3117 [Electronic] United States
• PMID: 16962479 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Heparin
• Urokinase-Type Plasminogen Activator

Topics

• Animals
• Cadaver
• Dogs
• Fibrinolysis (drug effects)
• Heart Arrest (physiopathology)
• Heart Massage
• Heparin (pharmacology)
• Injections, Intravenous
• Lung (drug effects, physiology)
• Lung Transplantation (methods, physiology)
• Organ Preservation (methods)
• Organ Size (drug effects, physiology)
• Postmortem Changes
• Thrombosis (prevention & control)
• Tissue Donors
• Urokinase-Type Plasminogen Activator (administration & dosage, pharmacology)
• Vascular Resistance (drug effects, physiology)