Allo-transplantation of the Lung Preserved 24 Hour with UW Solution and the Preventive Effect of Flush with Leukocyte-depleted Blood before Reperfusion.

The purpose of this study was to evaluate the possibility of clinical use of a 24 hour preserved donor lung with UW solution and the effects of the flush with Leukocyte depleted before reperfusion. The left canine lung was used for allotransplantation and dogs were divided into 4 groups. The donor lungs preserved for 24 hours with UW solution (Group 1 and 2) or EC solution (Group 3 and 4)were transplanted in mongrel dogs. Moreover, the flush with Leukocytedepleted blood for 30-60 minutes was performed in Group 2 and 4. The severity of reperfusion injury at 60 minutes of reperfusion was assessed and the graft funchion was observed for 14 days. The PaO2 value at 60 minutes of reperfusion was 345 ± 132, 261 ± 161, 312 ± 120, 152 ± 146 Torr, static compliance was 31.2 ± 4.5, 27.8 ± 5.0, 22.2 ± 9.0, 17.6 ± 6.1, and dynamic compliance was 13.9 ± 1.9, 14.2 ± 1.9, 10.9 ± 1.8, 11.7 ± 1.5 ml/cmH2O, respectively. There were no significant differences among the groups. And no significant deterioration was seen in these parameters as compared with the figures before harvesting. Pulmonary vascular resistance (PVR) was 1824 ± 650, 2100 ± 564, 3830 ± 1549, 4553 ± 1819 dyne sec cm-5 respectively. Group 1 and 2 showed significantly lower PVR than Group 3 and 4. Tissue Lipid Peroxide was 0.75 ± 0.15, 0.85 ± 0.21, 1.52 ± 0.85, 0.70 ± 0.27 nmolMDA/mg pt, and the ability of superoxide generation of neutrophils (SOX) was 4697 ± 1886, 4466 ± 1760, 6934 ± 156, 3125 ± 725 respectively at 60 minutes of reperfuison. Group 1, 2 and 4 showed better results than Group 3. There was a significant decrease in SOX of Group 4 as compared with Group 3. Recipients were administered Cyslospoline A (20 mg/kg/day) and Azachiopurine (2 mg/kg/day). The survival rates were 100% (6/6), 57% (4/7), 0% (0/4), 0% (0/4) respectively. And 4 of 6 in Group 1 and 3 of 7 in Group 2 functioned well with PaO2 of 354 ± 66, 317 ± 178 Torr at sacrifice (10 to 21 POD). And a slight rise in PVR was recognized in both groups as compared with the figures before harvesting. (2524 ± 894, 2947 ± 381 respectively) Histological examination after 60 minutes of reperfusion revealed mild interstitial edema in Group 1 and 2. Severe alveolar edema, marked vascular congestion, and perivascular extravasation were seen in Group 3 and 4, But the grade of vascular congestion was slightly lower in Group 4 as compared with that in Group 3. At sacrifice survivors showed rejection in three dogs and none in four dogs, in which interstitial thickening, diffues perivascular cuffing was seen. There was no significant difference between Group 1 and 2. The data suggest that UW solution may prepare the 24-hour-preserved donor lung for succesful lung transplantation. And the flush with leukocyte depleted blood showed attenuation of the tissue lipid peroxidation and superoxide generation of neutrophils in the lung preserved with EC but not with UW. The flush with leukocytedepleted blood may play a role in attenuation of neutrophils related reperfusion injury