Critical importance of the first 10 minutes of lung graft reperfusion after hypothermic storage

Background We have shown previously that lung graft function can be improved by achieving reperfusion with stepwise increments of perfusion pressure over 60 minutes. This study aimed to establish whether similar benefit could be achieved with a shorter, simpler protocol and different storage conditions. Methods Rat lungs were flushed with University of Wisconsin or modified Euro-Collins solution and reperfused for 1 hour with blood from a support animal. Grafts were reperfused immediately or after storage at 4°C for 24 hours (University of Wisconsin solution) or 6 hours (Euro-Collins solution). Stored-graft reperfusion was initiated with a 0-, 5-, or 10-minute period during which reperfusion pressure was reduced by 50%. Results Stored grafts receiving 0 or 5 minutes of initial low-pressure reperfusion performed poorly, with reduced oxygenation and blood flow and elevated pulmonary artery pressure, airway pressure, and wet/dry weight ratio. In contrast, 10 minutes of initial 50%pressure reperfusion yielded function comparable with that in controls with both storage conditions. Conclusions An initial 10-minute period of 50%pressure reperfusion improves the function of stored rat lung grafts, whereas 5 minutes is insufficient.