Improvement of lung preservation -- from experiment to clinical practice.
BACKGROUND
Reperfusion injury represents a severe early complication following lung transplantation. Among the pathogenetic factors, the high potassium content of Euro-Collins(reg) solution is discussed.


METHODS
In a pig model of orthotopic left-sided lung transplantation we investigated the effect of Euro-Collins solution (EC: n = 6) versus low potassium dextran (LPD: Perfadex: n = 6). Sham-operated (n = 6) animals served as control. Transplant function, cellular energy metabolism and endothelial morphology served as parameters. In a clinical investigation, 124 patients were evaluated following single (EC: n = 31; LPD n = 37) or double (EC: n = 17; LPD n = 39) lung transplantation, whose organs where preserved with EC (n = 48) or LPD (n = 76). Duration of ischemia, duration of ventilation and stay on ICU were registered. Primary transplant function was evaluated according to AaDO(2) values. Cause of early death (30 days) was declared.


RESULTS
Experimental results: After flush with EC and 18 h ischemia, a reduction of tissue ATP content (p < 0.01 vs inital value and LPD) was noted. Endothelial damage after ischemia was severe (p < 0.05 vs control), paO(2) was significantly decreased.


RESULTS
In the LPD group, duration of ischemia was longer for the grafts transplanted first (SLTx and DLTx: p = 0.0009) as well as second (2. organ DLTx: p = 0.045). Primary transplant function was improved (day 0: SLTx: p = 0.0015; DLTx: p = 0.0095, both vs EC). Duration of ventilation and stay on ICU were shorter (n.s.). Reperfusion injury-associated death was reduced from 8% (EC) to 0 (LPD).


CONCLUSIONS
In experimental lung preservation, LPD lead to an improved graft function. These results were confirmed in clinical lung transplantation. Clinical lung preservation, therefore, should be carried out by use of LPD.
Müller
C
C
Department of Surgery, Ludwig Maximilians University, Klinikum Grosshadern, Munich, Germany. christian.mueller@gch.med.uni-muenchen.de
Bittmann
I
I
Hatz
R
R
Kellner
B
B
Schelling
G
G
Fürst
H
H
Reichart
B
B
Schildberg
F W
FW
D000328:Adult; D000818:Animals; D003911:Dextrans / Q000627:therapeutic use*; D005260:Female; D005947:Glucose / Q000627:therapeutic use*; D006801:Humans; D006982:Hypertonic Solutions / Q000627:therapeutic use*; D008168:Lung / Q000502:physiology; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019188:Organ Preservation Solutions / Q000627:therapeutic use*; D015427:Reperfusion Injury / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D013552:Swine
D003911:Dextrans; C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D019188:Organ Preservation Solutions; C083290:low potassium dextran glucose solution; D005947:Glucose