Experimental lung preservation with perfadex: effect of the no-donor nitroglycerin on postischemic outcome

Abstract

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.

Pre-ischaemic exogenous surfactant reduces pulmonary injury in rat ischaemia/reperfusion

“…Therefore, effects resulting from the interaction between donor and host cannot be investigated. Perfadex1 was used as preservation solution for its proven efficacy in previous studies [6,43,44], except for in one group, which was flush perfused with NaCl to induce severe I/R injury. With regard to the surfactant preparation, it was decided that Curosurf1 derived from porcine lung tissue would be used, which contains the hydrophobic surfactant proteins B and C, and which is routinely applied for the treatment of neonatal respiratory distress syndrome [45].…”

Nitroglycerin Reperfusion Reduces Ischemia-Reperfusion Injury in Non-Heart-Beating Donor Lungs

“…In rat lungs flushed with cold Euro-Collins or Perfadex, the addition of NTG resulted in improved oxygenation, vascular resistance, and peak inspiratory pressures, probably due to less pulmonary edema. 58 Similar improvements in pulmonary edema were confirmed in an ex vivo rat lung perfusion system that also showed reduced oxidative DNA damage after 15 hours of cold storage in lungs flushed with NTG. 59 The addition of NTG to Celsior preservation solution was associated with vascular smooth muscle cell relaxation observed by electron microscopy and a higher vessel lumen-to-wall ratio consistent with vasodilation, but was also associated with swelling of alveolar epithelial and endothelial cells in rat lungs.…”

Pyruvate-Modified Perfadex Improves Lung Function After Long-Term Hypothermic Storage

“…The flow rate used during reperfusion (10 ml/min) is significantly lower than normal rat cardiac output but higher than that used by other investigators who use similar ex vivo models. 2,9,23 We have previously reported that lung metabolism in this model increases up to a flow rate of 10 ml/min. Higher flow rates do not further increase metabolism but result in progressive edema.…”

“…Although increasing oxidative metabolism may generate energy that protects the integrity of the vascular endothelium, other strategies, such as supporting the nitric oxide synthase reaction, have been found to be effective as well. [22][23][24] The optimal technique for lung preservation has yet to be established.…”