title: Comparison of Eurocollins and University of Wisconsin solution in single flush preservation of the ischemic reperfused lung: an in vivo rabbit model.
abstract: The standard preservation technique in lung transplantation is cold single pulmonary artery flush (PAF) with Eurocollins solution (ECS). We compared ECS with University of Wisconsin (UW) solution, with and without added indomethacin, in single PAF preservation in an in vivo rabbit model of warm ischemia-reperfusion lung injury. Six groups of four New Zealand white rabbits each underwent isolation and hilar stripping of the left lung. In the four experimental groups, the left lung was flushed with (15 ml/kg) of cold ECS or UW solution, with or without added indomethacin, before warm ischemia for 120 minutes and before reperfusion for 60 minutes. The remaining two groups were the nonischemic and the ischemic "no flush" controls. Transcapillary flux of 99mTechnitium-labeled albumin and electron microscopy were used to demonstrate lung injury. Pulmonary vascular resistance (PVR) and thromboxane B2 (TXB2) concentrations were measured. There was a significant rise in PVR after ischemia/reperfusion in the ischemic control group (54.7 +/- 13.9 to 117.8 +/- 20.7 mm Hg/L.min-1, P < 0.05). The net rise in PVR after ischemia-reperfusion was significantly smaller in the two groups in which indomethacin was added (16.8 +/- 17.5 and 4.5 +/- 10.6 mm Hg/L.min-1 for UW and ECS, respectively) compared with the ischemic control (63.1 +/- 24.6 mm Hg/L.min-1, P < 0.05). Post-reperfusion TXB2 levels tended to be lower in the nonischemic control group and in the indomethacin-flush groups. We conclude that the increase in PVR produced by unilateral ischemia-reperfusion lung injury in this model was improved by single PAF perfusion. There was no significant difference between UW solution and ECS in this regard. The addition of indomethacin to the flush solution was associated with lower PVRs as well as morphologic improvement by electron microscopy. These findings may indicate a prominent role for the provision of PG synthesis inhibition during preservation for lung transplantation.
authors.affiliation: Department of Cardiothoracic Surgery and Pediatric Critical Care, New England Medical Center, Boston, Massachusetts 02111, USA.
authors.forename: H H
authors.initials: HH
authors.lastname: Balkhy
authors.forename: M B
authors.initials: MB
authors.lastname: Peterson
authors.forename: R J
authors.initials: RJ
authors.lastname: Connolly
authors.forename: X
authors.initials: X
authors.lastname: Zhang
authors.forename: J T
authors.initials: JT
authors.lastname: Diehl
mesh_terms: D000241:Adenosine; D000493:Allopurinol; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D005978:Glutathione; D006982:Hypertonic Solutions; D007213:Indomethacin / Q000494:pharmacology; D007328:Insulin; D007511:Ischemia / Q000503:physiopathology*; D008168:Lung / Q000098:blood supply / Q000502:physiology; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011651:Pulmonary Artery / Q000187:drug effects / Q000502:physiology*; D011817:Rabbits; D011887:Raffinose; D015424:Reperfusion; D013929:Thromboxane B2 / Q000378:metabolism; D014655:Vascular Resistance
chemical_list: C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D013929:Thromboxane B2; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose; D010100:Oxygen; D007213:Indomethacin