Combined Use of Prostacyclin and
Higher Perfusate Temperatures
Further Enhances the Superior Lung
Preservation by Celsior Solution in
the Isolated Rat Lung
Thorsten Wittwer, MD,
a
Thorsten Wahlers, MD,
a
Antonia Fehrenbach, PhD,
a
Jan F. Cornelius,
a
Sebastian Elki,
a
Matthias Ochs, MD,
b
Heinz Fehrenbach, PhD,
c
Johannes Albes, MD,
d
Axel Haverich, MD,
a
and Joachim Richter, MD
b
Background: The poor tolerance of the lung to ischemia and reperfusion (IR) still
represents one of the limitations in clinically successful lung transplantation. Modified
Euro-Collins (EC) is routinely used in lung preservation, but alternative solutions have
been developed for improvement of pulmonary preservation. Celsior is an extracellular
solution that has significantly reduced the IR-induced pulmonary damage in animal
studies. So far, no extensive experimental studies exist concerning the influence of
Celsior on pulmonary gas exchange following IR.
Methods: In an extracorporeal rat lung model 10 lungs, each, were preserved with
Celsior (CE) and Celsior/prostacyclin (CEPC, 6 g/100 ml) at 4° and 15°C, each, and
compared to low-potassium Euro-Collins (EC-40, 40 mmol/liter potassium). After 2
hours of ischemia lungs were reventilated and reperfused using a roller pump.
Oxygenation in terms of oxygen partial tension in the left atrial effluent, pulmonary
vascular resistance (PVR), peak inspiratory pressure, and wet/dry ratio were monitored
for 50 minutes. Furthermore, edema formation was evaluated by light microscopy.
Statistical analysis was performed using ANOVA models.
Results: Compared to the EC-40 group, oxygenation was increased and amount of edema was
reduced in most Celsior-preserved organs ( p 0.032) with exception of the CEPC group at 4°C
( p = 0.06). Additional application of prostacyclin did not have any significant effect on
oxygenation in the Celsior group. However, after temperature elevation of the CEPC perfusate
to 15°C, a superior partial tension of oxygen was observed ( p 0.023) in contrast to the 4°C
groups CE and CEPC. The lowest PVR was found in the CE 4°C group ( p 0.02).
Conclusions: Celsior provides better lung preservation than EC-40 solution. Application of
prostacyclin at higher perfusate temperatures results in additional functional improvement.
In vivo experiments and ultrastructural analysis are warranted for further evaluation of
Celsior in lung preservation. J Heart Lung Transplant 1999;18:684–692.
From the Division of Cardiothoracic and Vascular Surgery,
Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Han-
nover.
a
the Division of Electron Microscopy, Center of Anat-
omy, University of Goettingen, Kreuzbergring 36, 37075, Goet-
tingen,
b
the Institute of Pathology, University Clinic, TU
Dresden, Fetscherstrasse 74, 01307 Dresden,
c
and the Division
of Cardiothoracic and Vascular Surgery, University Clinic,
Hoppe-Seyler-Strasse 3, 72076 Tuebingen,
d
Germany.
Submitted June 30, 1998; accepted November 17, 1998.
Reprint requests: Thorsten Wittwer, MD, Division of Cardiotho-
racic and Vascular Surgery, Medical School Hannover, Carl-
Neuberg-Strasse 1, 30625 Hannover, Germany. Tele: +49-511-
5326580. Fax: +49-511-5325404. E-mail: Th.Wittwer-MD@t-
online.de.
Copyright © 1999 by the International Society for Heart and
Lung Transplantation.
1053-2498/99/$–see front matter PII S1053-2498(98)00061-8
684