A Novel Experimental Porcine Model to Assess the Impact of Differential Pulmonary Blood Flow on Primary Graft Dysfunction After Unilateral Lung Transplantation

Abstract Background Primary graft dysfunction (PGD) remains a major obstacle after lung transplantation. We developed a novel approach to selectively assess reperfusion injury in transplanted lung and investigated the impact of pulmonary flow.Materials Twelve porcine left lung transplants were divided in two groups (n = 6, in low (LF) and high flow (HF) group). Donor lungs were stored for 24 hours on ice, followed by left lung transplantation. Recipient animals were observed for 6h after reperfusion with partially clamping of right PA in HF group. Results Survival at 6 hours was 100% in both groups. PaO2/FiO2 (P/F) ratio of the transplanted lung was lower (229.1 mmHg vs 308.9 mmHg, p=0.01), mPAP was higher (34.62 mmHg vs 29.88 p=0.01) in HF versus LF group. Wet-to-dry (W/D) ratios of right native and left transplanted lung were not different after 6 h of reperfusion. Conclusions Lung transplantation in large animal settings is feasible. P/F ratio in allograft is dependent on PA flow. Our innovative approach to control blood flow to transplanted lung demonstrates that higher flows induce more PGD and allows to further study development and treatment of PGD. Our findings might have an important impact on sequential intra-operative approach during lung transplantation.