Beneficial Effects of Leukocyte-depleted Blood and Low-potassium Dextran Solutions on Microvascular Permeability in Preserved Porcine Lung

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Abstract
Modified Euro-Collins (EC) solution, a crystalloid intracellular-type solution, has been commonly used for pulmonary preservation. Several experimental studies have shown the advantages of using extracellular colloid-based solutions. The aim of this study was to compare the quality of preserva- tion of two extracellular colloid solutions, leukocyte-depleted blood (BL) and low-potassium dextran (LPD) solutions, with that of EC solution. Lungs of 22 domestic pigs were flushed and preserved with EC (n 5 8), BL (n 5 7), or LPD (n 5 7) solution. After harvesting, one of the lungs was reper- fused immediately in an ex vivo circuit (control lungs), whereas the contralateral lung was reper- fused after 8 h of cold (4 8 C) storage (preserved lungs). Besides the lung function parameters (gas exchange, pulmonary hemodynamics and mechanics), the permeability of the endothelial-epithelial barrier was assessed by determining the transferrin leak index (TLI) using a double radioisotopic method, by measuring the alveolar / arterial protein concentration ratio, and by analyzing histo- pathologic changes. The functional quality (oxygenation, airway resistance, dynamic compliance (C L , dyn)) of both BL and LPD lungs was slightly but significantly superior to that of EC lungs. How- ever, pulmonary vascular resistance was lower in BL-preserved than in EC- or LPD-preserved lungs. The TLI was increased in EC control and preserved lungs, whereas it was low in BL and LPD control lungs and did not increase after preservation. The alveolar / arterial protein concentration ratio was not different between control groups, but was increased fourfold in EC-preserved compared with BL- or LPD-preserved lungs. Finally, EC-preserved lungs presented a weight gain about twice that of BL- and LPD-preserved lungs. Morphologic analysis confirmed these results, because in the EC-pre- served lungs, rupture of alveolar septa and severe alveolar edema and hemorrhage were observed, whereas BL- and LPD-preserved lungs showed a relatively well-preserved structure. The results dem- onstrate that both BL and LPD flush solutions preserve the endothelial-epithelial barrier better than does EC solution. Although the quality of preservation is similar, pulmonary vascular resistance is higher in LPD-preserved than in BL-preserved lungs. Schneuwly OD, Licker M, Pastor CM, Schwei- zer A, Slosman DO, Kapanci Y, Nicod LP, Robert J, Spiliopoulos A, Morel DR. Beneficial ef- fects of leukocyte-depleted blood and low-potassium dextran solutions on microvascular permeability in preserved porcine lung. AM J RESPIR CRIT CARE MED 1999;160:689-697. Pulmonary transplantation has proved successful in the treat- ment of selected patients with end-stage pulmonary disease. Improved preservation techniques have largely contributed to ameliorate the success of lung transplantation. A 1-yr patient survival rate greater than 90% for single lung transplantation and greater than 85% for bilateral lung transplantation has