EFFECT OF LUNG ALLOGRAFT ISCHEMIA DURATION ON POSTREPERFUSION GRAFT FUNCTION AND POSTOPERATIVE COURSE

Lung transplantation is limited by the effects of ischaemia, Previous clinical studies related graft ischaemia duration to postoperative pul monary function in the ICU, morbidity, and overall survival. This repo rt describes the intraoperative pulmonary allograft function immediate ly after reperfusion. 23 lung transplantations (15 bilateral, 8 single ) were analysed. Donor selection and organ procurement were identical. After pulmonary vasodilation with prostacyclin, allografts were flush -perfused with cold modified Euro-Collins solution. Mean duration of l ung ischaemia was 255.1 +/- 35.1 min (190-314 min). Ischaemia times di d not differ with respect to the recipient's disease or the use of ext racorporeal circulation. After reperfusion, oxygenation indices deteri orated in 73.9% of patients compared with the native lungs (313.4 +/- 163.5 vs 427.2 +/- 96.1, p = 0.006). Linear regression analysis and su bgroup analysis both revealed a significant influence of the duration of allograft ischaemia on early transplant function. Ischaemia of more than 4 hours resulted in an acceptable but significantly lower PaO2 ( 254.9 +/- 143.3 mmHg vs 463.0 +/- 149.2 mmHg, p = 0.011), However, mea n time until extubation and time spent in the ICU were not affected. I t is concluded that flush-perfusion of the lung with modified Euro-Col lins solution provides reliable preservation of lung function up to fo ur hours. Longer ischaemia, up to six hours, is followed by an accepta ble but progressively reduced early transplant function.