Preimplantation retrograde pneumoplegia in clinical lung transplantation

Objective: Retrograde pneumoplegia seems to improve early graft func- tion in experimental and clinical lung transplantation. We evaluated the role of retrograde flushing in addition to antegrade pneumoplegia in clinical lung transplantation. Methods: Fourteen patients undergoing lung transplantation were randomized into 2 groups: in group I we per- formed antegrade pulmonary artery flushing with alprostadil (prostaglandin E ) and modified Euro-Collins solution at the time of 1 retrieval. In group II additional retrograde flushing through the pul- monary veins was performed at the back table, before reimplantation. Hemodynamic variables, mean airway pressure, and blood gas analysis were monitored at different time points. Postoperative volumetric mon- itoring was performed to assess extravascular lung water. The reim- plantation response was assessed by a radiographic score; extubation time and intensive care unit stay were recorded. Results: During retro- grade flushing, blood and clots coming out from the pulmonary artery were observed; 2 lungs harvested from a donor with multiple bone frac- tures had fat emboli in the retrograde perfusate. Hemodynamic moni- toring did not demonstrate any difference between the 2 groups. The ratio of arterial oxygen tension to inspired oxygen fraction, extravascu- lar lung water, duration of intubation, and length of stay in the intensive care unit were improved in group II, but the differences did not reach statistical significance. Intrapulmonary shunt fraction was significantly improved in group II at each time point (P = .02), as well as indexed alve- olar-arterial oxygen tension gradient (P = .04), mean airway pressure (P = .04), and chest x-ray score (P = .03). Conclusions: Preimplantation ret- rograde flushing is not detrimental and helps to improve early graft function.