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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 480-491, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
H Date, A Matsumura, JK Manchester, H Obo, O Lima, JM Cooper, S Sundaresan, OH Lowry and JD Cooper
We used a canine left lung allotransplantation model to evaluate 24- hour
lung preservation with two different electrolyte solutions, low- potassium
dextran and low-potassium dextran with 1% glucose. To investigate changes
in the energy status during preservation, we analyzed the lungs for
adenosine triphosphate, phosphocreatine, and several metabolites of the
glycolysis pathway and the citric acid cycle: glucose, glucose-6-phosphate,
lactate, citrate, and malate. We also devised and evaluated a pulmonary
cooling jacket to prevent rewarming of the lung during implantation. The
lungs were divided into four groups. Groups I (n = 10) and II (n = 6) were
flushed with low- potassium dextran and groups III (n = 6) and IV (n = 6)
were flushed with low-potassium dextran solution with 1% glucose. The
cooling jacket was used for groups II and IV only. After 24-hour
preservation at 10 degrees C, the left lungs were implanted into the
recipient animals. Function of the transplanted left lung was assessed
during temporary (10 minutes) occlusion of the contralateral pulmonary
artery while both lungs were ventilated with 100% oxygen. This assessment
was performed at 1 hour and at 3, 8, and 22 days after transplantation.
Immediately after transplantation the arterial oxygen tension was 279 +/-
70 mm Hg in group I, 376 +/- 56 mm Hg in group II, 523 +/- 41 mm Hg in
group III, and 518 +/- 50 mm Hg in group IV. The arterial oxygen tension in
groups III and IV were significantly greater than in group I (p < 0.05).
Of the lungs preserved with low-potassium dextran solution with 1% glucose
solution, 11 of 12 (92%) showed excellent lung function (arterial oxygen
tension > 300 mm Hg) at 3 days; only 10 of 16 lungs preserved with
low-potassium dextran achieved this level of function. Glucose,
glucose-6-phosphate, lactate, citrate and malate levels decreased
significantly during 24-hour preservation with low-potassium dextran
solution; they were stable with low-potassium dextran solution with 1%
glucose. Adenosine triphosphate and phosphocreatine were stable for 24
hours with both low-potassium dextran and low-potassium dextran solution
with 1% glucose. The cooling jacket provided uniform cooling of the lung
parenchyma during implantation, and significant increase in temperature was
observed in its absence, with topical cooling by cold saline
solution.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Evaluation of lung metabolism during successful twenty-four-hour canine lung preservation
Department of Surgery, Washington University School of Medicine, Barnes Hospital, St. Louis, Mo.
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