Beneficial effect of initial warm crystalloid reperfusion in 6-hour lung preservation.
BACKGROUND
To achieve successful lung transplantation, it is essential to minimize reperfusion injury occurring as a result of metabolite accumulation during the preservation period or at the time of initial interaction of blood with constricted pulmonary vasculature. Initial reperfusion with warm crystalloid solution may be advantageous in preventing this injury.


METHODS
This study was designed to evaluate the effect of low-potassium (4 mmol/L) dextran (1%) solution as the initial warming solution after 6 hours of hypothermic storage. In 23 New Zealand White rabbits the lungs were flushed with low-potassium dextran solution (10 degrees C, 40 ml/kg, 600 cm H2O), excised, inflated with room air, and stored in a low-potassium dextran solution (10 degrees C) for 6 hours. After storage, the lungs were divided into two groups. Group 1 (n = 8) was reperfused with warm low potassium dextran for 4 minutes, at 37 degrees C followed by blood reperfusion for 30 minutes at 37 degrees C. Group II (n = 15) was reperfused only with blood for 30 minutes at 37 C. The mean pulmonary vascular resistance measured during cold flush and prior to storage was similar in both groups (group I = 20.0 +/- 5.9 mm Hg.sec/ml, group II = 19.3 +/- 1.9 mm Hg.sec/ml).


RESULTS
During reperfusion, only 4 of the 15 lungs in group II maintained an acceptable (< 80 mm Hg) mean pulmonary artery pressure; six failed immediately. All eight lungs in group I completed the 30-minute reperfusion (p < 0.005). The mean pulmonary artery pressure was significantly less, and effluent oxygen tension was significantly greater in group I during reperfusion.


CONCLUSIONS
In this experimental model, initial warm reperfusion with low-potassium dextran ameliorated the deleterious effects of reperfusion, thus providing an environment to improve lung preservation.
Moriyasu
K
K
Department of Surgery, University of South Florida, Tampa, USA.
McKeown
P P
PP
Novitzky
D
D
Snow
T R
TR
D000818:Animals; D001833:Body Temperature Regulation / Q000502:physiology*; D000077324:Crystalloid Solutions; D006085:Graft Survival / Q000502:physiology; D007552:Isotonic Solutions; D008168:Lung / Q000098:blood supply; D016040:Lung Transplantation / Q000379:methods* / Q000502:physiology; D009926:Organ Preservation / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010952:Plasma Substitutes; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D011817:Rabbits; D015532:Rehydration Solutions; D015424:Reperfusion / Q000379:methods*; D015427:Reperfusion Injury / Q000517:prevention & control*; D014655:Vascular Resistance / Q000502:physiology
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D015532:Rehydration Solutions; D010100:Oxygen