Abstract
Lung transplantation is limited by the effects of ischaemia. Previous clinical studies
related graft ischaemia duration to postoperative pulmonary function in the ICU, morbidity,
and overall survival. This report describes the intraoperative pulmonary allograft
function immediately 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 lung ischaemia was 255.1 ± 35.1 min
(190-314 min). Ischaemia times did not differ with respect to the recipient's disease
or the use of extracorporeal circulation. After reperfusion, oxygenation indices deteriorated
in 73.9% of patients compared with the native lungs (313.4 ± 163.5 vs427.2 ± 96.1,
p = 0.006). Linear regression ana lysis and subgroup 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, mean time until extubation
and time spent in the ICU were not affected. It is concluded that flush-perfusion
of the lung with modified Euro-Collins Solution provides reliable preservation of
lung function up to four hours. Longer ischaemia, up to six hours, is followed by
an acceptable but progressively reduced early transplant function.
Key words
Euro-Collins Solution - Ischaemia - Lung transplantation - Organ preservation
