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J Thorac Cardiovasc Surg 2000;119:488-492
© 2000 Mosby, Inc.

CARDIOTHORACIC TRANSPLANTATION

RAFFINOSE IMPROVES THE FUNCTION OF RAT PULMONARY GRAFTS STORED FOR TWENTY-FOUR HOURS IN LOW-POTASSIUM DEXTRAN SOLUTION

From the Thoracic Surgery Research Laboratory, Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.

Supported by the Canadian National Sanitarium Association and the Canadian Cystic Fibrosis Foundation.

Address for reprints: Shaf Keshavjee, MD, Director, Toronto Lung Transplant Program, Division of Thoracic Surgery, The Toronto General Hospital, 200 Elizabeth St, EN 10-224, Toronto, Ontario, Canada M5G 2C4 (E-mail: skeshavjee{at}uhn.on.ca ).

Objectives: The perfect strategy for pulmonary graft preservation remains elusive. Experimental work supports the use of perfusates, such as Euro-Collins, University of Wisconsin, and low-potassium dextran solutions. We use low-potassium dextran solution in our clinical program, but we aim for continued improvement. The trisaccharide raffinose has been shown to be responsible for the efficacy of University of Wisconsin perfusate in lung preservation. Raffinose is superior to a variety of other saccharides for this purpose. We tested the hypothesis that the addition of raffinose to low-potassium dextran solution might further improve graft function.
Methods: In a randomized blinded study with a rat left lung transplant model, donor lungs were flushed with either standard low-potassium dextran solution or low-potassium dextran solution modified by the addition of 30 mmol/L raffinose (n = 5 for each group). Alprostadil (prostaglandin E₁, 500 µg/L) was added to the perfusates in accordance with our clinical practice. Grafts were stored inflated at 4°C for 24 hours. After transplantation, recipients were ventilated with a fraction of inspired oxygen of 1 and a positive end-expiratory pressure of 2 cm H₂O. Graft function was evaluated by measuring oxygenation at 2 hours after graft reperfusion, peak airway pressure throughout the reperfusion period, and the wet/dry lung weight ratio.
Results: The group receiving low-potassium dextran solution with raffinose demonstrated significantly higher oxygenation (oxygen tension, 370 ± 45 mm Hg vs 150 ± 64 mm Hg; P = .0025), lower peak airway pressures at 2 hours after lung reperfusion (11 ± 2.7 mm Hg vs 16 ± 2.4 mm Hg; P < .001), and a lower wet/dry weight ratio (4.7 ± 1.26 vs 11 ± 5.0; P = .017).
Conclusion: Modification of low-potassium dextran solution with the trisaccharide raffinose resulted in a significant improvement in graft function in this model and merits further evaluation with respect to the mechanisms involved.

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