Safe lung preservation for twenty-four hours with perfadex

Abstract

The function of six porcine left lung allografts was studied after pulmonary (140 mL/kg) and bronchial (50 mL/kg) artery perfusion with Perfadex (Kabi Pharmacia, Uppsala, Sweden) at room temperature, followed by 24-hour storage of the lungs in an atelectatic state in 6 ° to 8 °C Perfadex, which is a low-potassium-dextran solution. Left lung transplantation was done followed by right pneumonectomy, thereby making all the animals 100% dependent for their survival on the transplanted lungs. The pigs (mean weight = 56 kg, range = 51 to 58 kg, n = 18; 6 donors, 6 recipients, and 6 shamoperated) were ventilated with a volume-controlled ventilator (20 breaths/min, 500 ml tidal volume, 8 cm H 2O positive end-expiratory pressure, inspired oxygen fraction = 0.5). All the transplanted animals were in good condition throughout the 24-hour observation period with arterial oxygen tensions around 25 kPa (188 mm Hg) and arterial carbon dioxide tensions around 5 kPa (38 mm Hg). The mean pulmonary arterial pressure was around 30 mm Hg, and the pulmonary vascular resistance around 500 dyn · s · cm −5; neither showed any tendency to change with time. After 24 hours the inspired oxygen fraction was increased to 1.0 and the arterial oxygen tension increased to 43.3 ± 5 kPa (325 ± 38 mm Hg) (mean ± standard error of the mean; n = 6). A sham operation (bilateral thoracotomy, right pneumonectomy) was done in 6 pigs, which were followed up for 24 hours. The arterial oxygen tensions in these pigs were around 30 kPa and the mean pulmonary arterial pressure and pulmonary vascular resistance around 24 mm Hg and 350 dyn · s · cm −5, respectively. This study demonstrates excellent pulmonary function after pulmonary and bronchial artery perfusion with Perfadex at room temperature followed by 24 hours of cold atelectatic storage in Perfadex.