Warm retrograde perfusion can remove more fat from lung grafts with fat embolism in a porcine model

  • Masahiro Irie
  • Shinji OtaniEmail author
  • Takeshi Kurosaki
  • Shin Tanaka
  • Takashi Ohki
  • Kentaroh Miyoshi
  • Seiichiro Sugimoto
  • Masaomi Yamane
  • Takahiro Oto
  • Shinichi Toyooka
Original Article



In lung transplantation, unexpected pulmonary emboli, including thrombi and fat, have been observed with high probability and are associated with potential primary graft dysfunction. We evaluated a new perfusion method using warm retrograde flushing that removes more fat than conventional cold retrograde flushing.


We developed a novel porcine donor model for pulmonary fat embolism by administering autologous fat in the left pulmonary artery. The left pulmonary artery and the left superior and inferior pulmonary veins were cannulated for flushing and collecting these solutions. After flushing, the left lung was reperfused under observation for 3 h. Two groups underwent warm and cold additional retrograde flush (WS; warm solution group, CS; cold solution group).


The fat removal rate in the antegrade flush was equal in both groups (3.0 ± 0.6% vs 3.0 ± 0.4%, p = 0.46); however, the rate was significantly greater in the WS group in retrograde flush (25.2 ± 3.2% vs 8.0 ± 1.4%, p = 0.01). Histology with Oil Red O staining and its software analysis showed more residual fat in the CS group (0.12 ± 0.01% vs 0.38 ± 0.07%, p = 0.01). There was no significant difference in the pulmonary function and hemodynamics during the 3-h period after reperfusion.


Warm retrograde perfusion can remove more fat from lung grafts with fat embolism in a porcine donor model.


Lung Transplantation Organ donor management Fat embolism 



We thank Tetsuo Kawakami for his technical assistance.


This study was supported by JSPS KAKENHI [Grant numbers #15K102570 (T.O.), #18K1642000 (T.K.)].

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.


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Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  • Masahiro Irie
    • 1
  • Shinji Otani
    • 2
    Email author
  • Takeshi Kurosaki
    • 2
  • Shin Tanaka
    • 1
  • Takashi Ohki
    • 1
  • Kentaroh Miyoshi
    • 1
  • Seiichiro Sugimoto
    • 1
  • Masaomi Yamane
    • 1
  • Takahiro Oto
    • 2
  • Shinichi Toyooka
    • 1
  1. 1.Department of General Thoracic Surgery and Breast and Endocrinological SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  2. 2.Department of Organ Transplant CenterOkayama University HospitalOkayamaJapan

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