CARDIOVASCULAR ENGINEERING Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
	Volume 2, 1997, No 1

Extracellular-Type Phosphate Buffered Solution for Long-Term Lung Preservation- Experimental Studies of Canine and Primate Lung Transplants

Y. Matsumura, T. Kondo, S. Fujimura, H. Ohura, M. Handa, R. Saito, M. Hirose, M. Sugita, T. Sado

Abstract:
Background: The purpose of this study was to determine an optimal composition of extracellular fluid (ECF) solution for lung preservation and to assess pulmonary graft function after long-term preservation. Methods: Thirty-one left lung allotransplantations were performed in dogs and Japanese monkeys. Simple hypothermic preservations of the lung for 48 and 96 hours were examined in dogs using four types of ECF like solutions (study I; group Ep1-Ep4, n=4 in each group). The pH and osmotic pressure was changed in each solution. Lung function was assessed by serial chest x-ray films, delayed right pulmonary artery occlusion test and histopathology. To assess graft function of the long-term preservation, 24-hr preservation and left lung transplantations were performed in monkeys (study II). Group 1 (n=5) underwent transplantation without preservation, group 2 (n=6) received allografts which were preserved for 24 hours using Ep4 solution. The temporary right pulmonary artery occlusion was performed immediately and 7 days after transplantation to assess lung function in allograft. Results: In the case of 48-hr. preservation, 4/4 recipients with Ep3 (pH: 7.225) showed good aeration on chest x-rays in the early postoperative period. As for the 96-hr. preservation cases, 1/4 with Ep3 and 3/4 with Ep4 (pH: 7.463) presented good x-ray findings after surgery. Of these successful cases, seven dogs underwent delayed right pulmonary artery occlusion. Six animals tolerated this preocedure except for one with a 96-hr. preserved lung. On histological examination of the successful cases, almost normal pulmonary structure was observed in the 48-hr. preserved cases , while the 96-hr. cases showed slight degenerative changes in the alveolar walls. Temporary contralateral pulmonary artery occlusion test, at immediately after transplantation and at POD 7, did not show any significant differences in gas exchange capacity and cardiopulmonary hemodynamics between group 1 and group 2 in study II. Historical examination of the lung biopsy samples did not show significant differences between 2 groups. Conclusion: The Ep4 solution (pH: 7.463, osmotic pressure 364 mOsm) showed excellent lung preservation effect up to 96-hr. Long-term hypothermic preservation with Ep4 solution dose not impair pulmonary function immediately after transplantation. The results of this study indicate that ECF solution such as Ep4 is applicable to clinical use.

Keywords:
lung transplantation, lung preservation, simple hypothermic storage, extracellular solution, dextran, phosphate buffered solution

Address for Correspondence:

Reference:
(CVE. 1997; 2 (1): 75-80)

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