Combined use of prostacyclin and higher perfusate temperatures further enhances the superior lung preservation by Celsior solution in the isolated rat lung

Background: The poor tolerance of the lung to ischemia and reperfusion (IR) still represents one of the limitations in clinically successful lung tran splantation. Modified Euro-Collins (EC) is routinely used in lung preservat ion, but alternative solutions have been developed for improvement of pulmo nary preservation. Celsior is an extracellular solution that has significan tly reduced the IR-induced pulmonary damage in animal studies. So far, no e xtensive experimental studies exist concerning the influence of Celsior on pulmonary gas exchange following IR. Methods: In an extracorporeal rat lung model 10 lungs, each, were preserved with Celsior (CE) and Celsior/prostacyclin (CEPC, 6 mu g/100 ml) at 4 degr ees and 15 degrees C, each, and compared to low-potassium Euro-Collins (EC- 40, 40 mmol/liter potassium). After 2 hours of ischemia lungs were reventil ated and reperfused using a roller pump. Oxygenation in terms of oxygen par tial tension in the left atrial effluent, pulmonary vascular resistance (PV R), peak inspiratory pressure, and wet/dry ratio were monitored for 50 minu tes. Furthermore, edema formation was evaluated by light microscopy. Statis tical analysis was performed using ANOVA models. Results: Compared to the EC-40 group, oxygenation was increased and amount of edema was reduced in most Celsior-preserved organs (p < 0.032) with exce ption of the CEPC group at 4 degrees C (p = 0.06). Additional application o f prostacyclin did not have any significant effect on oxygenation in the Ce lsior group. However, after temperature elevation of the CEPC perfusate to 15 degrees C, a superior partial tension of oxygen was observed (p < 0.023) in contrast to the 4 degrees C groups CE and CEPC. The lowest PVR was foun d in the CE 4 degrees C group (p < 0.02). Conclusions: Celsior provides better lung preservation than EC-40 solution. Application of prostacyclin at higher perfusate temperatures results in ad ditional functional improvement. In vivo experiments and ultrastructural an alysis are warranted for further evaluation of Celsior in lung preservation .