A new preservation solution for lung transplantation: Evaluation in a porcine transplantation model

BACKGROUND: Lung preservation injury is still a major problem in lung transplantation. The aim of the current study was to evaluate the effects of a new preservation solution (Custodiol-N) for lung preservation. METHODS: Using an in vivo pig model, 7 lungs each were preserved for 24 hours after perfusion with: low-potassium dextran (LPD) solution as control (Group 1); base solution of Custodiol-N without iron chelators (Group II); Custodiol-N (Group III); or Custodiol-N supplemented with dextran 40 (Group IV). Four animals received a sham operation. After left lung transplantation and contralateral lung exclusion, hemodynamics and blood gases were monitored for 6 hours; tissue samples were taken at the end of the experiments. RESULTS: All animals survived the transplantation procedure. Base solution and Custodiol-N preserved lungs (Groups IT and III) showed graft function similar to that of LPD-preserved lungs (Group I), showing a trend toward improved values. Custodiol-N with dextran (Group IV) led to a significant reduction of mean pulmonary arterial pressure (20 +/- 2 vs 28 +/- 3 mm Hg, p < 0.01) and pulmonary vascular resistance (410 +/- 51 vs 588 +/- 83 dyne/s/cm(5), p < 0.01), and oxygenation ratio was significantly higher (536 +/- 52 vs 313 +/- 107 mm Hg at 6 hours, p < 0.01) and PCO2 values were significantly lower (51 +/- 9 vs 77 +/- 5 mm Hg at 6 hours, p < 0.01) at 6 hours compared with LPD (Group I). Custodiol-N (Groups 11 to IV) showed a trend toward a lower wet/dry ratio and reduced oxidative stress; in the presence of dextran (Group IV), the difference was again statistically significant, when compared with LPD (Group I). CONCLUSIONS: Custodiol-N solution is a new alternative preservation solution for lung transplantation that offers significantly superior protection compared with LPD when dextran 40 is added. J Heart Lung Transplant 2012;31:310-7 (C) 2012 International Society for Heart and Lung Transplantation. All rights reserved.