Pulmonary blood flow is inhomogeneously reduced after Euro Collins-preservation and lung transplantation

BACKGROUND: Vasoconstriction after lung transplantation is a well-known phenomenon, but only limited information is available on blood flow distribution after ischemia and reperfusion. The aim of our study was to determine the regional flow characteristics in transplanted and native dog lungs after 24 hours of cold storage and preservation with Euro Collins-solution. METHODS: Six pairs of weight-matched Foxhounds (25 to 30 kg) were used. In donors and recipients, aortic and pulmonary artery catheters were inserted percutaneously and a reference withdrawal catheter was placed into the main pulmonary artery. For preservation, the lungs were perfused with modified Euro Collins-solution and stored at 4 degrees C. After 24 hours, the left lung was transplanted. Regional pulmonary blood flow was assessed by injection of colored microspheres into the right atrium using the reference withdrawal technique. Measurements of regional pulmonary blood flow were conducted twice in donors and recipients (baseline and 3 hours after reperfusion). Tissue samples from five distinct regions (apical, medial, dorsal, ventral, and lateral) were taken to assess regional pulmonary blood flow and wet-dry ratios. RESULTS: The relative (per thousand Confidence Intervals/100 mg dry weight) regional pulmonary blood flow was significantly reduced in the transplanted lung but not in the native organ. This reduction was most pronounced in apical regions and smallest in regions close to the hilum. Edema formation occurred in both lungs, as judged from wet-to-dry ratios of lung tissue specimen. CONCLUSIONS: Two separate processes can be observed after single lung transplantation: (1) reduced regional pulmonary blood flow, which is a regional phenomenon restricted to the transplanted organ, and (2) extensive edema affecting both the transplanted and the native lung.