The contribution of donor management and modified cold blood lung perfusate to post-transplant lung function

Background: Donor organ availability remains the major limiting factor in t he treatment of patients with end-stage lung disease by lung transplantatio n. Maximising the use of available organs is therefore crucial. Details ava ilable at the time of organ; referral may give a misleading impression of t heir quality. Intensive donor management may improve the quality of the org ans thereby improving the quality of the outcome. Methods: We performed 56 heart-lung and 5 double lung transplants between N ovember 1990 and September 1993; 49 had adequate documentation for analysis . All organs were preserved with modified cold blood solution with an ischa emic time of 197 (117-297) minutes. Assessment of lung function post-implan tation was performed using an acute lung injury score as this gives a more accurate indication of overall lung function. Donors were treated intensive ly by bronchoscopy, optimal fluid management and appropriate lung expansion . Results: Careful management improved donor quality so that the alveolar-art erial oxygen gradient fell significantly from 185 (+/-20) mmHg at arrival t o 80 (+/-11) mmHg (p <.0001) immediately prior to harvesting 190 minutes la ter. This improvement was maintained following harvesting using the modifie d cold blood preservation solution so that lung injury was assessed as "mil d" according to the acute lung injury criteria posttransplantation. There w as one instance of primary lung failure following transplantation which was neither related to the quality of the organ at harvesting nor to the metho d of lung preservation. Conclusions: Intensive donor management significantly improves the quality of donor organs, providing an improvement in immediate post-transplantation lung function. This improvement is maintained using modified cold blood lu ng preservation solution.