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J Thorac Cardiovasc Surg 1996;112:111-116
© 1996 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

EURO-COLLINS SOLUTION EXACERBATES LUNG INJURY IN THE SETTING OF HIGH-FLOW REPERFUSION

This work was supported, in part, by the NIH under RO-1 grant HL 48242 and NRSA fellowship No. 5 F32 HL 08940. Additional support from CNPq—Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil.

Received for publication April 18, 1995 Accepted for publication Sept. 8, 1995. Address for reprints: Irving L. Kron, MD, Division of Thoracic and Cardiovascular Surgery, Box 310, Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, VA 22908.

Abstract

Single-lung transplantation has been abandoned for the treatment of pulmonary hypertension by many centers because of overperfusion of the graft following implantation. Euro-Collins solution is currently used for lung preservation despite the vasoconstrictive effect of this intracellular-type solution. We hypothesized that high-flow reperfusion, alone or in combination with Euro-Collins–induced vasoconstriction, may cause lung dysfunction. Twenty-eight New Zealand White rabbit lungs were harvested and studied in an isolated, blood-perfused model of lung function after 4 hours of cold ischemia. Control lungs were preserved with 50 ml/kg cold saline solution flush and reperfused at either normal flow (60 ml/min) or high flow (120 ml/min). Experimental lungs were preserved with 50 ml/kg cold Euro-Collins solution and reperfused at normal or high flow rates. The arteriovenous oxygen gradient at the end of the 30-minute reperfusion period was significantly lower in the high-flow versus the low-flow experimental group (31.1 ± 4.2 vs 130.6 ± 41.6 mm Hg, p < 0.05). The pulmonary vascular resistance was increased in the high-flow groups and the experimental groups, with a statistically significant difference between low-flow experimental and control groups (64374.4 ± 5722.6 vs 37041.5 ± 2110.9 dynesseccm^–5, p < 0.001). The percentage decrease in dynamic airway compliance in the high-flow experimental group was markedly different from that in the high-flow control group (–51% ± 13.3% vs –10.15% ± 3.4%, p < 0.05). Similarly, the wet/dry ratio of the lungs in the high-flow experimental group (13.92 ± 2.32) was significantly greater than that in the low-flow experimental group (6.27 ± 0.19, p < 0.01) and than that in the high-flow control group (5.88 ± 0.23, p < 0.001). These data demonstrate that high-flow reperfusion and preservation with Euro-Collins solution are deleterious to lung function, both individually and in combination, in an ex vivo rabbit lung model. Lung preservation with Euro-Collins solution may not be optimal when high-flow reperfusion is anticipated, as in the setting of unilateral lung transplantation for pulmonary hypertension. (J THORAC CARDIOVASC SURG 1996;112:111-6)

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