Thorac Cardiovasc Surg 2005; 53 - V111
DOI: 10.1055/s-2005-862054

Experimental lung transplantation – impact of preservation solution and route of delivery

T Wittwer 1, U Franke 1, A Fehrenbach 2, M Ochs 2, T Sandhaus 1, A Schuette 1, S Richter 1, N Dreyer 2, T Müller 3, H Schubert 3, J Richter 2, T Wahlers 1
  • 1Friedrich-Schiller Universität, Klinik für Herz-, Thorax- und Gefäßchirurgie, Jena
  • 2Universität Göttingen, Abt. Elektronenmikroskopie, Göttingen
  • 3Friedrich-Schiller Universität, Abt. f. Versuchstierkunde, Jena

Objectives: Optimal preservation of allograft integrity is essential to reduce postischemic organ dysfunction following lung transplantation. Retrograde organ preservation leads to homogeneous intrapulmonary distribution and eliminates intravascular thrombi. So far, no comparative studies exist concerning the preservation quality following retrograde preservation with Perfadex and Celsior after extended cold ischemic intervals.

Material and Methods: In an in-vivo pig model 5 lungs, each, were preserved for 27 hours using antegrade or retrograde perfusion techniques with Celsior (CE ante/CE retro) and Perfadex (PER ante/PER retro). Following left lung transplantation and contralateral lung exclusion, hemodynamics, oxygenation and dynamic compliance were monitored for 6 hours and compared to sham-operated controls. Pulmonary edema was determined stereologically. Statistics comprised ANOVA analysis with repeated measures.

Results: Mortality of all Celsior-protected lungs was 100% due to severe reperfusion injury with profound lung edema. In contrast, organ preservation with PER ante led to sufficient graft function without mortality. Preservation quality following retrograde administration of Perfadex resulted in optimised oxygenation capacity as compared to PER ante (p=0.046). Furthermore, intraalveolar edema was reduced and generally comparable with sham controls. Generally, retrograde preservation led to a continous washout of small blood and fibrin clots from the pulmonary capillary system.

Conclusions: Perfadex solution provides sufficient lung preservation for 27 hours of cold ischemia, and its retrograde application leads to significant functional and histological improvement as compared to antegrade perfusion. In contrast, preservation with Celsior solution results in lethal postischemic outcome regardless of the route of administration and therefore has to be considered not suitable for extended lung procurement.