The Annals of Thoracic Surgery, Vol 23, 487-494, Copyright © 1977 by The Society of Thoracic Surgeons
Lung preservation techniques
LH Toledo-Pereyra, T Hau, RL Simmons and JS Najarian
Some of the barriers to successful lung transplantation include the lack of
acceptable methods for ischemic protection and the absence of reliable
systems for preservation. The lung response to 60 minutes of warm ischemia
basically consists of alveolar-capillary edema and disruption, mitochondria
swelling, interstitial hemorrhage, significantly depressed pulmonary
function, elevation of pulmonary vascular resistance, and considerable drop
in levels of glucose, phospholipids, and adenosine triphosphate. The
tolerance to warm ischemia increases to several hours with the use of
different systems of ventilatory assistance with or without positive
end-expiratory pressure. Several methods of preservation have been
attempted: hypothermia, hyperbaria, and hypothermic pulsatile or
nonpulsatile perfusion. Hypothermic pulsatile perfusion appears to offer
longer periods of protection than the other methods. Longer periods of
ischemia and extended preservation may be made possible by advances in the
use of drug protection during warm ischemia and the utilization of
intracellular colloid or noncolloid solutions for hypothermic storage or
hypothermic pulsatile perfusion.
