Effective Application of ET-Kyoto Solution for Clinical Lung Transplantation F. Chen, T. Fukuse, S. Hasegawa, T. Bando, N. Hanaoka, M. Kawashima, H. Sakai, H. Hamakawa, T. Fujinaga, T. Nakamura, and H. Wada ABSTRACT The shortage of lung donors and ischemia-reperfusion injury following transplantation have been grave problems in lung transplantation (LTx). One of the most important strategies to solve these problems is the development of effective and highly reliable methods for lung preservation. Therefore, we developed a new organ preservation solution, namely, the extracellular-type trehalose-containing Kyoto (ET-Kyoto) solu- tion. Here we report the first experience of clinical application of ET-Kyoto solution for cadaveric LTx. The recipient was a 38-year-old man with pulmonary emphysema. The donor was a 51-year-old male current smoker with a smoking history of 62 pack-years. The ventilated donor’s PaO 2 was 340 Torr (FiO 2 = 1.0). The pulmonary vasculature was flushed with ET-Kyoto solution supplemented with nitroglycerine and dibutyryl cAMP. The recipient underwent bilateral sequential LTx on cardiopulmonary bypass. The ischemic time was 544 and 613 minutes for the left and right lung, respectively. PaO 2 (FiO 2 = 1.0) was 385 Torr immediately after reperfusion. The donor lung was so large that bilateral partial resections were performed at 413 minutes (right) and 348 minutes (left) after reperfusion. On histopathologic examination of the resected transplanted lungs the structure was almost normal. Postoperatively, PaO 2 (FiO 2 = 1.0) was over 400 Torr with or maximum of 526 Torr. The clinical course was almost uneventful. In conclusion, ET-Kyoto solution may be safely applied in clinical cadaveric LTx with extended donor lungs and relatively long ischemic times. Func- tional and histopathological efficiency of ET-Kyoto solution was confirmed. Longer preservation times with preserved quality using ET-Kyoto solution would increase the donor pool and enable semielective LTx. L UNG TRANSPLANTATION (LTx) is an established therapeutic procedure for a variety of end-stage lung diseases. More than 1400 LTx operations are now per- formed throughout the world each year. 1 On the other hand, the shortage of lung donors and ischemia-reperfusion injury following transplantation have been grave problems in LTx. One of the most important strategies to solve these problems is the development of effective, highly reliable methods for lung preservation. Therefore, we have devel- oped a new organ preservation solution, namely, the extra- cellular-type trehalose-containing Kyoto (ET-Kyoto) solu- tion (Table 1). 2 Recently, University of Wisconsin (UW) solution and low potassium dextran (LPD) solution have been reported to improve early graft failure. 3,4 UW solution differs from other two solutions because it contains high potassium. The major difference between LPD solution and ET-Kyoto solution is the type of saccharide (ie, glucose [monosaccharide] and trehalose [nonreducing disaccha- ride], respectively). Experimentally, trehalose is superior to glucose for cytoprotection. 5 We herein report the first experience of clinical application of ET-Kyoto solution for cadaveric LTx. From the Department of Thoracic Surgery, Kyoto University, 54 Shogoin, Sakyo-ku, Kyoto, Japan. Address reprint requests to Tatsuo Fukuse, MD, PhD, Depart- ment of Thoracic Surgery, Kyoto University, 54 Shogoin, Sakyo- ku, Kyoto 606-8507, Japan. E-mail: fukuse@kuhp.kyoto-u.ac.jp 0041-1345/04/$–see front matter © 2004 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2004.10.005 360 Park Avenue South, New York, NY 10010-1710 2812 Transplantation Proceedings, 36, 2812–2815 (2004)