DISTANT ORGAN PROCUREMENT IN CLINICAL LUNG TRANSPLANTATION AND HEART-LUNG TRANSPLANTATION - COOLING BY EXTRACORPOREAL-CIRCULATION OR HYPOTHERMIC FLUSH

The scarcity of suitable donors for single lung and heart-lungtransplantation calls for methods of medium-term pulmonary preservation to allow for distant organ procurement. At our institution, the first five grafts (four heart-lung, one single lung) were cooled by means of atransportable extracorporeal circulation unit, while the last eight grafts(four heart-lung, four single lung) were flush-perfused with modified coldEuro-Collins solution. The technique of extra corporated circulation included aortic and right atrial cannulation and cooling to 12 degrees-14 degrees C (rectal temperature) using a bubble oxygenator. Bypass time sranged between 41 and 52 min. Following excision, the organs were transported in ice-cold donor blood for is chemic times from 171 to 310 min. For cold flush preservation, simultaneous coronary (cold St. Thomas's solution) and pulmonary artery perfusion (Euro- Collins solution, 50 ml/kg over 4 min) were initiated simultaneously. The organs were transported in cold Euro-Collins solution for ischemic times of 175 to 270 min. Inheart-lung transplantations the first postoperative arterial PO2 upon arrival at the intensive care unit was 120 ± 38 Torr in the extracorporeal circulation and 140 ± 38 Torr in the Euro-Collins solutiongroup. Six of eight patients were extubated with in 48h after cardiopulmonary grafting. We conclude that pulmonary function follow ingheart-lung or single lung preservation with simple hypothermic flush is as good or better than that following extracorporeal circulation. Since distant organ retrieval is much more convenient without the latter, preservation using Euro-Collins solution is preferred. © Springer-Verlag.