Low Potassium Dextran Glucose(LPDG) 용액을 이용한 24시간 폐보존 연구

Abstract

Background: The shortage of donors has become a key issue in the field of lung transplantation. Numerous studies on safe long term preservation for lung transplantation has been performed for the purpose of developing ideal preservation solution with extracellular type or intracellular type solutions. We prepared modified Euro-Collins solution as intracellular type and LPDG(Low potassium dextran glucose) solution as extracellular type solution. In this study, we examined the efficacy of LPDG solution in 24-hour lung preservation by comparison with modified Euro-Collins solution. Methods: Seventeen pairs of adult mongrel dogs were divided into two groups. Donor lungs were flushed with LPDG solution(n=9) or modified Euro-Collins solution(n=8) and stored for 24 hours at 10°C. All donor lungs were treated with prostaglandin El and verapamil in each flushing solutions. Left canine lung allotransplantations were performed. Assessment(hemodynamic indices and arterial blood gas analysis) of left implanted lungs was made by occluding the right pulmonary arlery for ten minutes using pulmonary artery Cuff. Assessment was performed at the interval of 30 minutes, one hour, and two hours later after reperfusion and then chest X-ray, computed tomogram and lung perfusion scan were performed. In survival dogs follows-up were done with assessment with chest X-ray, computed tomogram of the chest and lung perfusion scan for above 7 days postoperatively. After 24 hours preservation, pathological examinations for ultrastructural findings on right lung were performed in each group. Results: With respect to arterial blood gas analysis and hemodyanmics, LPDG group showed, better condition in PaO2，mean pulmonary arteTy pressure(p<0.05) and cardiac output(p<0.05) than ME-C group until post-reperfusion 2 hours. After reperfusion 2 hours, both groups showed transplanted lung function deteriorated step by step. Perfusion scan of the transplanted lung in LPDG group showed better perfusion rate in immediate post-reperfusion，3 days and 7 days later respectively but there was no statistical significance and corelation with PaO2 and computed tomographic views. Conclusions: We concluded that LPDG solution added with PGE1 and verapamil can offer safe 24-hour lung preservation with adequate immunosuppressive therapy and prevention of the infection.