Lung preservation: a review of current practice and future directions

During the past 10 years, pulmonary transplantation has emerged as a successful mode of surgical therapy for suitable patients with end-stage lung disease. Current preservation techniques of donor lungs for subsequent transplantation include core-cooling and single flush perfusion. The relative merits of these are described. These methods are essentially restricted to 6 hours of ischemia. Research in lung preservation is aimed not only at extending the safe period of ischemia but also at improving the quality of preservation. Areas of interest include the ideal composition of the perfusate, relevant pharmacologic additives, and the best conditions for preservation and harvesting. Advantages and disadvantages of the various animal models are listed in addition to the methods used in assessing the quality of preservation. There have been major advances in experimental lung preservation during the past 10 years, and we are possibly on the threshold of incorporating some of these into clinical practice. Among the most important are the adoption of colloid-based perfusates, the more widespread use of free radical scavengers, and the use of leukocyte depletion.