Euro-collins solution exacerbates lung injury in the setting of high-flow reperfusion

Abstract

Single-lung transplantation has been abandoned for the treatment of pulmonary hypertension by many centers because of overperfusion of the graft following implantation. Euro-Collins solution is currently used for lung preservation despite the vasoconstrictive effect of this intracellular-type solution. We hypothesized that high-flow reperfusion, alone or in combination with Euro-Collins-induced vasoconstriction, may cause lung dysfunction. Twenty-eight New Zealand White rabbit lungs were harvested and studied in an isolated, blood-perfused model of lung function after 4 hours of cold ischemia. Control lungs were preserved with 50 ml/kg cold saline solution flush and reperfused at either normal flow (60 ml/min) or high flow (120 ml/min). Experimental lungs were preserved with 50 ml/kg cold Euro-Collins solution and reperfused at normal or high flow rates. The arteriovenous oxygen gradient at the end of the 30-minute reperfusion period was significantly lower in the high-flow versus the low-flow experimental group (31.1 +/- 4.2 vs 130.6 +/- 41.6 mm Hg, p < 0.05). The pulmonary vascular resistance was increased in the high-flow groups and the experimental groups, with a statistically significant difference between low-flow experimental and control groups (64374.4 +/- 5722.6 vs 37041.5 +/- 2110.9 dynes x sec x cm(-5), p < 0.001). The percentage decrease in dynamic airway compliance in the high-flow experimental group was markedly different from that in the high-flow control group (-51% +/- 13.3% vs -10.15% +/- 3.4%, p < 0.05). Similarly, the wet/dry ratio of the lungs in the high-flow experimental group (13.92 +/- 2.32) was significantly greater than that in the low-flow experimental group (6.27 +/- 0.19, p < 0.01) and than that in the high-flow control group (5.88 +/- 0.23, p < 0.001). These data demonstrate that high-flow reperfusion and preservation with Euro-Collins solution are deleterious to lung function, both individually and in combination, in an ex vivo rabbit lung model. Lung preservation with Euro-Collins solution may not be optimal when high-flow reperfusion is anticipated, as in the setting of unilateral lung transplantation for pulmonary hypertension.

Increased Intraoperative Fluid Administration Is Associated with Severe Primary Graft Dysfunction After Lung Transplantation

“…33 An increased CVP, defined as CVP > 7 mmHg after lung reperfusion, has been associated with prolonged mechanical ventilation, longer ICU stay and increased mortality. 14 These authors used CVP as a surrogate for increased fluid administration and concluded that low cardiac filling pressures may improve outcomes in lung transplant patients.…”

Increased Intraoperative Fluid Administration Is Associated With Severe Primary Graft Dysfunction After Lung Transplantation

“…33 An increased CVP, defined as CVP > 7 mmHg after lung reperfusion, has been associated with prolonged mechanical ventilation, longer ICU stay and increased mortality. 14 These authors used CVP as a surrogate for increased fluid administration and concluded that low cardiac filling pressures may improve outcomes in lung transplant patients.…”

Improvement of Rat Lung Structure and Function after Preservation with Celsior

“…Therefore, this in vitro method has been used as a simple, reliable, and reproducible means for screening the various factors of lung preservation [27][28][29][30]. Modifications improving the technique for the demands of a small organ have been investigated with respect to ischemic time and storage temperature [5,31].…”