Amelioration of pulmonary allograft injury by administering a second rinse solution

AbstractObjective: The use of rinse solutions before reperfusing liver allografts has been shown to reduce cell death in rats. Carolina rinse solution (an extracellular solution that contains antioxidants, vasodilators, and other substrates that help prevent ischemia-reperfusion injury) has also been shown to improve liver function clinically in liver transplant recipients. This pilot study evaluates the value of a second pulmonary artery flush before reperfusion of a lung graft. Methods: Six groups of Sprague-Dawley rats (n = 6 each) were subjected to the following: Group 1 lungs were preserved with modified Euro-Collins solution followed by 24 hours of cold ischemia. Group 2 lungs were treated the same as group 1 but reperfused with blood. Group 3 lungs were preserved in Carolina rinse solution followed by 24 hours of cold ischemia. Group 4 lungs were treated the same as group 3 lungs and then reperfused with blood. Lungs in groups 5 and 6 were preserved with Euro-Collins solution, stored cold for 24 hours, and then rinsed with Euro-Collins or Carolina rinse solution, respectively, before reperfusion with blood. Lungs were subsequently stained with trypan blue solution for 5 minutes. Lung blocks were fixed and embedded in water-soluble methacrylate. Trypan blue–stained nuclei in nonviable endothelial cells and alveolar pneumocytes were counted in 10 different fields. Results: Groups 1 and 3, preserved with Euro-Collins and Carolina rinse solutions for 24 hours but not reperfused with blood, had significantly more viable endothelial cells (groups 1 and 3 vs group 2, p < 0.0001; group 3 vs group 4, p < 0.02) and pneumocytes (group 1 vs groups 2 and 4, group 3 versus group 2, p < 0.0001; group 3 vs group 4; p < 0.035) than groups 2 and 4, which were subsequently reperfused with blood. Groups 5 and 6, which received a second rinse, also had significantly more viable endothelial cells (p < 0.0005) and pneumocytes (p < 0.0001) than control groups, which were not rinsed before reperfusion. Conclusions: We conclude that damage to pulmonary allografts resulting from prolonged ischemia is accentuated by reperfusion with blood. We also conclude that preservation with a single flush of Euro-Collins or Carolina rinse solution does not offer adequate protection, whereas a second rinse before reperfusion significantly decreases the number of damaged cells within the allograft. (J THORAC CARDIOVASC SURG 1996;112:1010-6

Early humoral changes in the lung allograft

The effects of ischemia/reperfusion injury on humoral changes in canines that underwent left lung allotransplantation was compared to autotransplantation (n = 10 each). Cytokines IL-2, TNF-a and IFN-g were measured in bronchoalveolar lavage (BAL) and plasma samples at 1, 4, 24 hours and 1 week postoperatively. In the allograft there was an early postoperative increase in all cytokines in BAL which decreased after 24 hours. The same trend was seen for IL-2 in the autograft. In contrast, TNF-a and IFN-g levels in the autograft remained unchanged. Using immunohistochemical staining techniques, MHC II antigen expression was observed on lung allograft bronchial epithelium which was less intense in the autograft. Hematoxylin and eosin staining of lung biopsies revealed early evidence of lung injury and also grade 1-2 rejection after 1 week in the allograft. Injury was not as severe in the autograft. We conclude that a temporary elevation of cytokines early after allotransplantation is partly due to ischemia/reperfusion injury and graft allogenicity. This early cytokine release may play an important role in the development of early graft dysfunction and rejection

Partial Bowls Using the Haemonetics Cell Saver 5: Does It Produce a Quality Product?

Controversy still exists on the validity of processing a partial bowl during the collection of shed blood lost through surgery during cell salvaging. The purpose of this study was to assess the quality of red blood cells produced from a partial bowl of autologous suctioned blood using the Haemonetics Cell Saver 5. Suctioned blood was collected from 17 patients undergoing cardiac surgery. A partially filled cell saver bowl was washed with 1500 mL of NaCl. Reservoir and processed blood samples were examined for potassium, leukocytes, hematocrit, platelets, and plasma-free hemoglobin and then compared with 22 previously studied full bowls. Results are summarized in the table below: In conclusion, the Haemonetics Cell Saver 5 can produce a quality product from washing a partial bowl with a better washout of white blood cells compared with a full bowl. However, there is a reduction in red blood cell recovery

Quality of Red Blood Cells Using Autotransfusion Devices: A Comparative Analysis

Cell salvage devices are routinely used to process and wash red blood cells (RBCs) shed during surgical interventions. Although the principle theory of cell saving is the same, the actual process to achieve this is very different from one device to another. The purpose of this study was to compare the quality of washed, concentrated RBC produced by five very different cell-saving devices, specifically the Cobe BRAT 2, Medtronic Sequestra 1000, Haemonetics Cell Saver 5, Medtronic Autolog, and the Fresenius CATS. Reservoir and washed red blood cells were analyzed for hematocrit (Hct), platelets (PLT), leukocytes (WBC), potassium (K+), heparin, plasma-free hemoglobin (PFH), RBC mass recovery and recovery rate. The Haemonetics and BRAT 2 had the highest RBC recovery. All devices adequately removed heparin and potassium. The Medtronic Autolog had the highest removal of platelets and PFH; whereas, the BRAT had the lowest. Although the Autolog had the highest leukocyte removal, leukocytes were not adequately washed out by any of the autotransfusion devices. In conclusion, although all cell- saving devices use the same theory of centrifugation, the actual quality of the washed RBC product differs widely from one device to another