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J Thorac Cardiovasc Surg 2000;120:566-572
© 2000 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Low-potassium dextran solution ameliorates reperfusion injury of the lung and protects surfactant function

From the Division of Thoracic and Cardiovascular Surgery^a and the Department of Pneumology,^b Hannover Medical School, Hannover, Germany.

Address for reprints: Martin Strüber, MD, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl Neuberg Str. 1, 30623 Hannover, Germany (E-mail: strueber{at}thg.mh-hannover.de ).

Objective: This study was designed to compare the effect of lung preservation with low-potassium dextran solution and Euro-Collins solution on reperfusion injury and surfactant function by using an in situ model of warm ischemia.
Methods: The left lungs of 6 minipigs were selectively perfused with Euro-Collins solution. In an additional 6 animals low-potassium dextran solution was used for flush perfusion. After 90 minutes of warm ischemia, the lungs were reperfused, and the contralateral pulmonary artery and bronchus were clamped. Hemodynamic and respiratory measurements were obtained for 7 hours of reperfusion. Surface tension of bronchoalveolar lavage and surfactant small and large aggregates were determined before perfusion (right lung) and after 2 hours of reperfusion (left lung).
Results: In the group receiving Euro-Collins solution, right heart failure developed within 215 ± 39 minutes of reperfusion. An increase in minimal surface tension (P = .03), surfactant small aggregates/large aggregates ratio (P = .003), and bronchoalveolar lavage protein content (P = .012) were found after 2 hours of reperfusion. In the group receiving low-potassium dextran solution, all minipigs survived (P = .0001). Dynamic lung compliance (P = .034) and oxygen tension/inspired oxygen fraction ratios were higher (P = .0001). Lung water content was lower (P = .049). The increase of minimal surface tension (P = .02) and bronchoalveolar lavage protein concentration (P = .015) were significantly less.
Conclusion: Preservation of the lung with Euro-Collins solution leads to a reduction of physical surfactant function during reperfusion. Low-potassium dextran solution protects surfactant function and metabolism, thereby reducing reperfusion injury of the lung.

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