title: Euro-Collins solution exacerbates lung injury in the setting of high-flow reperfusion.
abstract: Single-lung transplantation has been abandoned for the treatment of pulmonary hypertension by many centers because of overperfusion of the graft following implantation. Euro-Collins solution is currently used for lung preservation despite the vasoconstrictive effect of this intracellular-type solution. We hypothesized that high-flow reperfusion, alone or in combination with Euro-Collins-induced vasoconstriction, may cause lung dysfunction. Twenty-eight New Zealand White rabbit lungs were harvested and studied in an isolated, blood-perfused model of lung function after 4 hours of cold ischemia. Control lungs were preserved with 50 ml/kg cold saline solution flush and reperfused at either normal flow (60 ml/min) or high flow (120 ml/min). Experimental lungs were preserved with 50 ml/kg cold Euro-Collins solution and reperfused at normal or high flow rates. The arteriovenous oxygen gradient at the end of the 30-minute reperfusion period was significantly lower in the high-flow versus the low-flow experimental group (31.1 +/- 4.2 vs 130.6 +/- 41.6 mm Hg, p < 0.05). The pulmonary vascular resistance was increased in the high-flow groups and the experimental groups, with a statistically significant difference between low-flow experimental and control groups (64374.4 +/- 5722.6 vs 37041.5 +/- 2110.9 dynes x sec x cm(-5), p < 0.001). The percentage decrease in dynamic airway compliance in the high-flow experimental group was markedly different from that in the high-flow control group (-51% +/- 13.3% vs -10.15% +/- 3.4%, p < 0.05). Similarly, the wet/dry ratio of the lungs in the high-flow experimental group (13.92 +/- 2.32) was significantly greater than that in the low-flow experimental group (6.27 +/- 0.19, p < 0.01) and than that in the high-flow control group (5.88 +/- 0.23, p < 0.001). These data demonstrate that high-flow reperfusion and preservation with Euro-Collins solution are deleterious to lung function, both individually and in combination, in an ex vivo rabbit lung model. Lung preservation with Euro-Collins solution may not be optimal when high-flow reperfusion is anticipated, as in the setting of unilateral lung transplantation for pulmonary hypertension.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, VA, USA.
authors.forename: N F
authors.initials: NF
authors.lastname: DeLima
authors.forename: O A
authors.initials: OA
authors.lastname: Binns
authors.forename: S A
authors.initials: SA
authors.lastname: Buchanan
authors.forename: M C
authors.initials: MC
authors.lastname: Mauney
authors.forename: J T
authors.initials: JT
authors.lastname: Cope
authors.forename: K S
authors.initials: KS
authors.lastname: Shockey
authors.forename: C G
authors.initials: CG
authors.lastname: Tribble
authors.forename: I L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D000818:Animals; D006982:Hypertonic Solutions / Q000009:adverse effects*; D008168:Lung / Q000098:blood supply / Q000503:physiopathology*; D016040:Lung Transplantation; D009926:Organ Preservation / Q000379:methods*; D011817:Rabbits; D015427:Reperfusion Injury / Q000209:etiology*; D013997:Time Factors; D014655:Vascular Resistance
chemical_list: C037096:Euro-Collins' solution; D006982:Hypertonic Solutions