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J Thorac Cardiovasc Surg 2006;131:724-729
© 2006 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Glycine intravenous donor preconditioning is superior to glycine supplementation to low-potassium dextran flush preservation and improves graft function in a large animal lung transplantation model after 24 hours of cold ischemia

Hannover Thoracic Transplant Program, Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany

The results of this study were presented at the 25th anniversary meeting and scientific sessions of the International Society for Heart and Lung Transplantation, April 6-9, 2005, in Philadelphia, Pa.

^_* Address for reprints: Martin Strueber, MD, Director, Hannover Thoracic Transplant Program, Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany (Email: strueber.martin{at}tmh-hannover.de).

OBJECTIVES: The potential role of glycine in combination with standard lung preservation with low-potassium dextran solution in lung ischemia-reperfusion injury has not been investigated in a preclinical porcine transplant model.

METHODS: In a control group (n = 6), donor lungs were flushed with 1 liter of low-potassium dextran solution. In a second group (LPD-glyc, n = 6), low-potassium dextran solution was supplemented with 3.75 g of glycine. In a third group (IV-glyc, n = 6), donor preconditioning was performed by intravenous administration of 3.75 g glycine 1 hour before low-potassium dextran preservation. Grafts were stored in low-potassium dextran at 4°C for 24 hours. Posttransplant graft function was assessed throughout a 7-hour observation period.

RESULTS: In the control group, 2 recipients died of right-sided heart failure caused by severe ischemia-reperfusion injury. All animals of the glycine groups survived the entire observation period. Pulmonary vascular resistance remained significantly (P < .01) lower in both glycine groups when compared with controls. At the end of the observation period pulmonary vascular resistance in the control group was higher (P < .01) compared with the glycine groups (1310 ± 319 dyn x sec x cm^–5 vs 879 ± 127 dyn x sec x cm^–5 [LPD-glyc] vs 663 ± 191 dyn x sec x cm^–5 [IV-glyc]). Changes of lung tissue water content were lower in the IV-glyc group compared with the LPD-control (P < .01) and LPD-glyc lungs (P < .05). Oxygenation (PO ₂/FIO ₂) was higher in the IV-glyc group compared with the LPD-glyc and control lungs (445 ± 110 mm Hg vs 388 ± 124 mm Hg [P < .01] vs 341 ± 224 mm Hg [P < .001], respectively).

DISCUSSION: Modification of low-potassium dextran solution with glycine or donor preconditioning ameliorates ischemia-reperfusion injury in lung transplantation. This intriguing approach merits further evaluation with respect to the mechanisms involved and may improve results in clinical lung preservation.

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