EURO-COLLINS FLUSH PERFUSION IN HUMAN LUNG PRESERVATION-ULTRASTRUCTURAL STUDIES OF THE PRESERVATION QUALITY OF THE CONTRALATERAL DONOR LUNGIN CLINICAL SINGLE-LUNG TRANSPLANTATION

The quality of pulmonary preservation after Euro-Collins flush perfusi on was assessed by means of morphometric analysis based on transmissio n electron microscopy. In five patients undergoing single lung transpl antation, the contralateral donor lung that could not be matched for a nother recipient was studied by means of light microscopy and transmis sion electron microscopy. While one of the donor lungs was transplante d, the contralateral lung was fixed by airway instillation at the same time and subsequently processed for microscopic examination. Although light microscopy showed an excellent quality of organ preservation, t ransmission electron microscopy revealed the presence of fine to mediu m alterations at the level of the air-blood-barrier. In the five contr alateral donor lungs, different degrees of the cellular alterations we re recorded by morphometric analysis, which correlated with difference s observed in the early postoperative course of the patients receiving the other lung, respectively. Although in four of five patients the c linical course showed no complications and extubation was performed wi thin 36 hours after the operation, one patient required artificial ven tilation over a period of 10 days because of impaired oxygenation of t he transplanted lung. In this patient, morphometric analysis of the ai r-blood-barrier showed a significantly (p < 0.02) smaller surface frac tion of normal type 1 pneumocytes, a significantly (p < 0.05) smaller volume density of the capillary endothelial cells, and a significantly (p < 0.01) higher volume density of type 2 pneumocytes. The alteratio ns of the alveolar epithelium have to be interpreted as a result of in fluences occurring during the donor's medical history rather than bein g an effect of preservation and/or ischemia.