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J Thorac Cardiovasc Surg 2003;125:1208-1216
© 2003 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Experimental lung preservation with Perfadex: Effect of the NO-donor nitroglycerin on postischemic outcome

From the Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller University, Jena,^a and the Department of Electron Microscopy, University of Göttingen, Göttingen, Germany.^b

Supported by a grant from the Deutsche Forschungsgemeinschaft (DFG, Wa 738/3-4 and Ri 790/1-4).

Received for publication May 30, 2002. Revisions requested Aug 22, 2002; revisions received Oct 7, 2002. Accepted for publication Oct 18, 2002. Address for reprints: Thorsten Wittwer, MD, Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller University, Bachstrasse 18, 07740, Jena, Germany (E-mail: Th.Wittwer-MD{at}t-online.de).

Objective: Optimal preservation of postischemic graft function is essential in lung transplantation. Antegrade flush perfusion with modified Euro-Collins solution represents the standard technique worldwide. However, growing evidence suggests the superiority of extracellular-type Perfadex solution (Vitrolife AB, Gothenburg, Germany) over Euro-Collins solution. During ischemia and reperfusion, endogenous pulmonary nitric oxide synthesis is decreased, and therefore therapeutic stimulation of the nitric oxide pathway might be beneficial in ameliorating ischemia-reperfusion damage. However, research mainly focuses on nitric oxide supplementation of intracellular solutions, and no studies exist in which the effect of nitroglycerin on Perfadex preservation quality is evaluated.
Methods: Eight rat lungs each were preserved with Perfadex solution with or without nitroglycerin (0.1 mg/mL) and compared with low-potassium Euro-Collins solution. Postischemic lungs were reventilated and reperfused, and oxygenation capacity, pulmonary vascular resistance, and peak inspiratory pressures were monitored continuously. Stereological analysis was used for evaluation of pulmonary edema and assessment of the vasculature. Statistics were performed by using different analysis of variance models.
Results: The oxygenation capacity of the Perfadex-preserved groups was higher compared with that of the low-potassium Euro-Collins solution group (P < .03). By using nitroglycerin, flush-perfusion time was reduced, and Perfadex solution with nitroglycerin-protected lungs showed superior oxygenation capacity compared with that seen in Perfadex solution-protected organs (P < .01). Furthermore, pulmonary vascular resistance and peak inspiratory pressures were improved in the nitroglycerin group (P < .01). Stereology revealed comparable intrapulmonary edema between groups and a trend toward less vasoconstricted vasculature in Perfadex with nitroglycerin-protected lungs.
Conclusions: Perfadex solution provides superior lung preservation in terms of postischemic oxygenation capacity than Euro-Collins solution. Supplementation of the nitric oxide pathway by nitroglycerin further enhances functional outcome of Perfadex-preserved organs and might be an easily applicable tool in clinical lung transplantation.

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