Experimental lung transplantation: impact of preservation solution and route of delivery.
BACKGROUND
Optimal preservation of allograft integrity is essential to reduce post-ischemic organ dysfunction after lung transplantation. Retrograde organ preservation leads to homogeneous intrapulmonary distribution and eliminates intravascular thrombi. So far, no comparative studies exist with regard to preservation quality following retrograde preservation with Perfadex and Celsior after extended cold-ischemia intervals.


METHODS
In an in vivo pig model, 5 lungs each were preserved for 27 hours using antegrade or retrograde perfusion techniques with Celsior (Ce(ant)/CE(ret)) and Perfadex (PER(ant)/PER(ret)). After left lung transplantation and contralateral lung exclusion, hemodynamics, oxygenation and dynamic compliance were monitored for 6 hours and compared with sham-operated controls. Pulmonary edema was determined stereologically. Statistics consisted of analysis of variance (ANOVA) with repeated measures.


RESULTS
Mortality of all Celsior-protected lungs was 100% due to severe reperfusion injury with profound lung edema. In contrast, organ preservation with PER(ant) led to sufficient graft function without mortality. Preservation quality after retrograde administration of Perfadex resulted in optimized oxygenation capacity compared with PER(ant) (p = 0.046). Furthermore, intra-alveolar edema was reduced and generally comparable with sham controls. In general, retrograde preservation led to continuous washout of small blood and fibrin clots from the pulmonary capillary system.


CONCLUSIONS
Perfadex solution provided sufficient lung preservation for 27 hours of cold ischemia, and its retrograde application led to significant functional and histologic improvement compared with antegrade perfusion. In contrast, preservation with Celsior solution resulted in lethal post-ischemic outcome, regardless of the route of administration, and therefore must be considered unsuitable for extended lung procurement.
Wittwer
Thorsten
T
Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller University, Jena, Germany. th.wittwer-md@t-online.de
Franke
Ulrich F W
UF
Fehrenbach
Antonia
A
Ochs
Matthias
M
Sandhaus
Tim
T
Schuette
Alex
A
Richter
Stefan
S
Dreyer
Niels
N
Knudsen
Lars
L
Müller
Thomas
T
Schubert
Harald
H
Richter
Joachim
J
Wahlers
Thorsten
T
D000704:Analysis of Variance; D000818:Animals; D004195:Disease Models, Animal; D016503:Drug Delivery Systems; D005260:Female; D006084:Graft Rejection / Q000473:pathology*; D006085:Graft Survival; D007150:Immunohistochemistry; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D011336:Probability; D011897:Random Allocation; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D015996:Survival Rate; D034421:Sus scrofa
D019188:Organ Preservation Solutions