Primary lung graft failure is common, and current lung preservation strategies are suboptimal. Because the decline in lung levels of cyclic
adenosine monophosphate and cyclic
guanosine monophosphate during preservation could enhance adhesiveness of endothelial cells for leukocytes as well as increase vascular permeability and vasoconstriction, we hypothesized that buttressing these levels by means of a preservation
solution would significantly improve lung preservation.
METHODS: RESULTS: Among all groups studied, grafts stored with Columbia University
solution demonstrated the highest Pa O2 (355 +/- 25 mm Hg for Columbia University
solution versus 95 +/- 22 mm Hg for
Euro-Collins solution, P <.01, 172 +/- 55 mm Hg for University of Wisconsin
solution, P <.05, 76 +/- 15 mm Hg for
low-potassium dextran glucose solution, P <.01, and 82 +/- 25 mm Hg for Columbia University
solution without cyclic
adenosine monophosphate or
nitroglycerin, P <.01) and the lowest pulmonary vascular resistances (1 +/- 0.2 mm Hg * mL-1 * min-1 for Columbia University
solution versus 12 +/- 4 mm Hg * mL-1 * min-1 for
Euro-Collins solution, P <.01, 9 +/- 2 mm Hg * mL-1 * min-1 for University of Wisconsin
solution, 14 +/- 6 mm Hg * mL-1 * min-1 for
low-potassium dextran glucose solution, P <.01, and 8 +/- 2 mm Hg * mL-1 * min-1 for Columbia University
solution without cyclic
adenosine monophosphate and
nitroglycerin). These functional and hemodynamic improvements provided by Columbia University
solution were accompanied by decreased graft
leukostasis and decreased recipient
tumor necrosis factor alpha and
interleukin 1alpha levels compared with the other groups. In
toto, these improvements translated into superior survival among recipients of Columbia University
solution-preserved grafts (100% for Columbia University
solution, 37% for
Euro-Collins solution, P <.01, 50% for University of Wisconsin
solution, P <.05, 50% for
low-potassium dextran glucose solution, P <.05, and 13% for Columbia University
solution without cyclic
adenosine monophosphate and
nitroglycerin, P <.01).
CONCLUSION: