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Ann Thorac Surg 2000;69:1685
© 2000 The Society of Thoracic Surgeons
DR LYNN H. HARRISON (New Orleans, LA): I disagree with one of your conclusions. You said you thought that the reperfusion injury was not related to period of ischemia, but I think the only thing you showed was that there was no significant difference in your two groups in terms of duration of ischemia. You did not show that there is a threshold beyond which injury will be manifested in patients with pulmonary hypertension. Also, do you have any histology on those patients in the group with pulmonary hypertension who died?
DR KING: We do not have any histology at this time regarding the exact occurrences in that patient population, however, with regard to your first question, we did not separate out lesser periods of ischemia with regard to the pulmonary hypertension group and perhaps we should go back and look at that again, that is, see if there is a significant difference in the pulmonary hypertension group with regard to duration of ischemia.
DR R. DUANE DAVIS, JR (Durham, NC): I enjoyed your presentation. Reperfusion injury is a major problem and limitation in lung transplantation. A couple of questions. One, did you look at not just total ischemic time but actually the warm ischemic time, as related to the development of reperfusion injury? And, two, did you look at this over the course of your experience from 1990 to 1998, because what I think most of us are seeing is that the incidence and severity of ischemia-reperfusion injury have gradually declined over this period. Furthermore, did you change how you preserved the lungs, and, more specifically, what are you doing for your recipient, because I think recipient characteristics have more to do with ischemia-reperfusion events than occur with regard to the donor lung.
DR KING: With regard to the first question, of course it would be very hard to fully elucidate the duration of warm ischemia in the donor due to the fact that there is a rather large database that we would have to contact our organ and donation agency to retrieve those data. We are going to look at that.
DR DAVIS: Warm ischemia is related to the recipient’s operation, from the time the lung is placed into the thorax until reperfusion, and is usually unrelated to your organ procurement agency.
DR KING: We have not looked at that interval of warm ischemia immediately at the time of operation. No, we have not. Your second question was, have we changed the way we preserve the lung, and I know currently we still use a Euro-Collins-based solution with an initial bolus of prostaglandin before infusion, and basically I think that is the method we have used since its inception, and we have not changed from that form of preservation at this time.
DR DAVIS: Are you seeing the same amount of ischemia-reperfusion injury that you saw in 1990 that you are seeing now?
DR KING: I think we are seeing similar occurrences due to the fact that we really have not changed our techniques or methods since we started lung transplantation at the University of Virginia, but then again, we have not collected those data to be absolutely certain that that is the case.
DR DAVIS: Have you changed anything with regard to your recipients? Are you using any of the interleukin-2 receptor antagonists and seeing any difference?
DR KING: No.
DR DAVIS: No induction therapy?
DR KING: No.
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