Effects of flushing temperature and preservation solution on alveolar fluid clearance in the preserved rat lungs

Alveolar liquid clearance and sodium channel expression are decreased in transplanted canine lungs

To determine the impact of transplantation-associated injury on the clearance mechanisms of pulmonary edema, we created a canine single lung transplant model. After 3 hours of preservation and 4 hours of reperfusion, right native lungs and left transplanted lungs were used to measure alveolar liquid clearance (ALC) in ex vivo liquid-filled lung preparations. We also examined the role of the pulmonary circulation in edema clearance in in vivo liquid-filled lungs between 4 and 8 hours of reperfusion. To study molecular modifications in ALC, we also measured expression levels of the epithelial sodium channel (ENaC) and sodium-potassium-adenosine triphosphatase (ATPase). We found that ALC was significantly lower in transplanted than in right native lungs ex vivo (p < 0.05) and that transplanted lungs did not respond to the beta-adrenergic agonist terbutaline. Our in vivo study confirmed the ex vivo results. Molecular analyses revealed that ENaC messenger RNA but not sodium-potassium-ATPase was significantly decreased in transplanted lungs (p < 0.01). Furthermore, there was a significant decrease in ENaC protein expression. Therefore, we conclude that the current investigation indicates that the lung injury caused by lung preservation and transplantation significantly reduces the edema clearance ability of transplanted lungs.

Combined use of prostacyclin and higher perfusate temperatures further enhances the superior lung preservation by Celsior solution in the isolated rat lung

BACKGROUND

The poor tolerance of the lung to ischemia and reperfusion (IR) still represents one of the limitations in clinically successful lung transplantation. Modified Euro-Collins (EC) is routinely used in lung preservation, but alternative solutions have been developed for improvement of pulmonary preservation. Celsior is an extracellular solution that has significantly reduced the IR-induced pulmonary damage in animal studies. So far, no extensive experimental studies exist concerning the influence of Celsior on pulmonary gas exchange following IR.

METHODS

In an extracorporeal rat lung model 10 lungs, each, were preserved with Celsior (CE) and Celsior/prostacyclin (CEPC, 6 microg/100 ml) at 4 degrees and 15 degrees C, each, and compared to low-potassium Euro-Collins (EC-40, 40 mmol/liter potassium). After 2 hours of ischemia lungs were reventilated and reperfused using a roller pump. Oxygenation in terms of oxygen partial tension in the left atrial effluent, pulmonary vascular resistance (PVR), peak inspiratory pressure, and wet/dry ratio were monitored for 50 minutes. Furthermore, edema formation was evaluated by light microscopy. Statistical analysis was performed using ANOVA models.

RESULTS

Compared to the EC-40 group, oxygenation was increased and amount of edema was reduced in most Celsior-preserved organs (p<0.032) with exception of the CEPC group at 4 degrees C (p = 0.06). Additional application of prostacyclin did not have any significant effect on oxygenation in the Celsior group. However, after temperature elevation of the CEPC perfusate to 15 degrees C, a superior partial tension of oxygen was observed (p<0.023) in contrast to the 4 degrees C groups CE and CEPC. The lowest PVR was found in the CE 4 degrees C group (p<0.02).

CONCLUSIONS

Celsior provides better lung preservation than EC-40 solution. Application of prostacyclin at higher perfusate temperatures results in additional functional improvement. In vivo experiments and ultrastructural analysis are warranted for further evaluation of Celsior in lung preservation.

Effects of intraalveolar oxygen concentration on alveolar fluid absorption and metabolism in isolated rat lungs

We evaluated the effects of intraalveolar oxygen concentration on alveolar fluid absorption and metabolism in isolated rat lungs. Alveolar fluid absorption was determined by measuring increase in albumin concentration in the instillate solution during 2 h of incubation. Oxidative phosphorylation was assessed by gas analysis of the solution. Glycolysis was assessed by determining glucose escape and lactate release in the solution. We found that alveolar fluid absorption did not change under hyperoxic and hypoxic experimental environments (range 100-10% oxygen). Glycolysis was reduced under hyperoxia and stimulated under hypoxia, however, lung ATP content did not change. When oxidative phosphorylation was inhibited by NaCN, both alveolar fluid absorption and lung ATP content were reduced. Our data indicate that isolated rat lungs maintain optimal energy production for alveolar fluid absorption by stimulating glycolysis, even though glycolysis alone is not enough. We conclude that alveolar fluid absorption determined in isolated rat lungs is not influenced by intraalveolar oxygen concentration in the range above 10% oxygen.

Transalveolar fluid absorption ability in rat lungs preserved with Euro-Collins solution and EP4 solution

BACKGROUND

Pulmonary reimplantation response, presenting lung edema, is a major obstacle of lung transplantation. Transalveolar fluid absorption mechanism, regulated by active transalveolar Na+ transport via Na+ channel and Na+-K+-ATPase, is considered to be essential for resolution of lung edema. We investigated the effect of lung preservation on this fluid transport mechanism.

METHODS

The rat lungs were flushed and preserved with either EP4 solution (EP4) or Euro-Collins solution (EC). First, we determined the basal transalveolar fluid movement by calculating alveolar fluid clearance (AFC) after pulmonary flushing, 24- and 72-hr preservation. Then, we assessed the effects of Na+ channel blocker, amiloride, and Na+-K+-ATPase inhibitor, ouabain, on AFC after 24-hr preservation. We further measured lung ATP content and Na+-K+-ATPase activity after 24-hr preservation to evaluate cellular metabolism and enzymatic activity during preservation.

RESULTS

We found that the lungs preserved with EC showed significantly lower AFC and less inhibitory effects of both blockers than with EP4 after 24-hr preservation. Na+-K+-ATPase activity was significantly lower with EC than with EP4, even though lung ATP content was not affected by preservation solution.

CONCLUSIONS

EP4 preservation provides a better environment for maintaining transalveolar fluid absorption mechanism than EC preservation. Therefore, lung preservation with EP4 may ensure more reliable ability in resolving pulmonary edema.