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J Thorac Cardiovasc Surg 1996;112:569-576
© 1996 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

A NEWLY DEVELOPED SOLUTION ENHANCES THIRTY-HOUR PRESERVATION IN A CANINE LUNG TRANSPLANTATION MODEL

From the Department of Thoracic Surgery, Chest Disease Research Institute, Kyoto University, Kyoto, Japan.

Received for publication Oct. 24, 1995 Revisions requested Jan. 1, 1996, revisions received Jan. 31, 1996 Accepted for publication Feb. 5, 1995. Address for reprints: Hiromi Wada, MD, Department of Thoracic Surgery, Chest Disease Research Institute, Kyoto University, 53 Shogoin Sakyo-ku, Kyoto 606, Japan.

Abstract

Ischemia and reperfusion cause the production of oxygen free radicals. These damage grafts or disrupt normal vascular homeostatic mechanisms, with a parallel reduction in endothelial nitric oxide and adenosine 3',5'-cyclic monophosphate levels. We hypothesized that lung preservation failure may be related to these events. To improve lung preservation, we prepared a new ET-Kyoto solution, which contains N-acetylcysteine (a radical scavenger), nitroglycerin (to elevate the nitric oxide level), and dibutyryl adenosine 3',5'-cyclic monophosphate (to elevate the adenosine 3',5'-cyclic monophosphate level) and examined its efficacy in a canine single-lung transplantation model. Lungs were flushed with new ET-Kyoto solution (group I, n = 9), basal ET-Kyoto solution (group II, n = 6), basal ET-Kyoto solution plus ethanol and propylene glycol (solvents of nitroglycerin; group III, n = 6), or low-potassium dextran glucose solution (group IV, n = 6), and stored at 4º C for 30 hours. After left single-lung transplantation, the right main bronchus and right pulmonary artery were ligated and the functions of the transplanted lung were assessed for 6 hours. Arterial oxygen tension was significantly higher in group I than in groups II, III, and IV (p < 0.05). Peak inspiratory pressure and wet-to-dry lung weight ratio were significantly lower in group I than in groups II and IV (p < 0.01). Histologic and ultrastructural studies showed better preservation in group I than in groups II, III, and IV. We conclude that the new ET-Kyoto solution provides enhanced 30-hour lung preservation. (J THORAC CARDIOVASC SURG 1996;112:569-76)

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