BOTH BLOOD AND CRYSTALLOID-BASED EXTRACELLULAR SOLUTIONS ARE SUPERIORTO INTRACELLULAR SOLUTIONS FOR LUNG PRESERVATION

Objective: Lung transplantation remains limited by donor organ ischemi c time, inadequate graft preservation, and reperfusion injury, We eval uated lung preservation with use of an extracellular solution, with or without the addition of blood, as compared with preservation with the intracellular Euro-Collins solution, Methods: With use of an isolated , whole blood perfused/ventilated rabbit lung model, we studied three groups of animals, Lungs were flushed with Euro-Collins, low-potassium dextran, or 20% blood-low-potassium dextran solution, Lungs were harv ested en bloc, stored inflated at 4 degrees C for 18 hours, and then r eperfused at 60 ml/min,vith whole blood, Continuous measurements of pu lmonary artery pressure, pulmonary vascular resistance, and dynamic ai rway compliance were obtained, Fresh, nonrecirculated venous blood was used to determine the single-pass pulmonary venous-arterial oxygen gr adient, Results: Lungs preserved with Euro-Collins solution demonstrat ed elevated pulmonary artery pressure and pulmonary vascular resistanc e when compared with those preserved with low-potassium dextran and 20 % blood-low-potassium dextran solutions (pulmonary artery pressure: 40 .8 +/- 2.2 mm Hg vs 28.9 +/- 2.4 mm Hg and 28.3 +/- 1.5 mm Hg, respect ively, p < 0.001; pulmonary vascular resistance: 46.0 +/- 3.1 x 10(3) dynes . sec . cm(-5) vs 29.0 +/- 4.2 x 10(3) dynes . sec . cm(-5) and 28.8 +/- 2.3 x 10(3) dynes . sec . cm(-5), respectively, p < 0.001), E uro-Collins solution-preserved lungs demonstrated a significant drop i n compliance when compared,vith those preserved with low-potassium dex tran and 20% blood-low-potassium dextran (-21.9% +/- 4.7% vs 1.8% +/- 3.3% and 1.4% +/- 6.2%, respectively; p = 0.002), Oxygenation was impr oved with low-potassium dextran and 20% blood-low-potassium dextran so lutions as compared with that with Euro-Collins solution (296.3 +/- 54 .6 mm Hg and 290.2 +/- 66.4 mm Hg, respectively, vs 37.2 +/- 4.6 mm Hg ; p = 0.001), Conclusions: Extracellular solutions provided superior p reservation of pulmonary function in this rabbit lung model of ischemi a-reperfusion. However, the addition of blood does not confer any demo nstrable advantage over low-potassium dextran solution alone with use of an 18-hour period of cold ischemia.