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Ann Thorac Surg 2001;71:1140-1145
© 2001 The Society of Thoracic Surgeons
a Thoracic Surgery Research Laboratory, Division of Thoracic Surgery, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
b Department of Pathology, Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada
c The Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
Accepted for publication December 20, 2000.
Address reprint requests to Dr Keshavjee, Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St, EN 10-224, Toronto, Ontario, Canada, M5G 2C4
e-mail: shaf.keshavjee{at}uhn.on.ca
Background. We have previously shown that the addition of raffinose to low potassium dextran (LPD) preservation solution improves transplanted rat lung function after 24 hours of storage. The mechanisms by which raffinose acts are unclear. The aim of this study was to examine the histologic and ultrastructural correlates of this enhanced pulmonary function after preservation with raffinose.
Methods. In a randomized, blinded study, rat lungs were flushed with LPD, or LPD containing 30 mmol/L of raffinose, and stored for 24 hours at 4°C. Control lungs were flushed with LPD but not stored (n = 5 each group). Changes in postpreservation edema were determined. In addition, lungs were flushed with a trypan blue solution to quantify cell death, and examined using both light and electron microscopy.
Results. The LPD lungs gained significantly more weight (25.5% ± 5.5%) compared with raffinose-LPD lungs (5.2% ± 5.3%; p < 0.0001). There were higher percentages of dead cells in the LPD lungs (29% ± 0.3% of total cells) compared with raffinose-LPD lungs (14% ± 1.4%; p < 0.001) and control lungs (0.2% ± 5%; p < 0.001). Control lungs maintained normal ultrastructure, whereas LPD lungs showed a decreased number of intact type II pneumocytes and significant cellular necrosis. Interstitial and alveolar edema with interstitial macrophage infiltration was also observed. Alveolar capillaries were collapsed. In contrast, raffinose-LPD lungs showed only mild alterations such as minimal interstitial edematous expansion, fewer damaged cells, and minimal capillary injury.
Conclusions. Raffinose exerts a cytoprotective effect on pulmonary grafts during preservation, which explains the previously documented improved function. This simple modification of LPD with raffinose may provide clinical benefit in extended pulmonary preservation.
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