Re: Retrogradein situversus antegrade pulmonary preservation in clinical lung transplantation: a single-centre experience

et al. Experimental lung transplantation: impact of preservation solution and route of delivery. SP et al. Surfactant function in lung transplantation after 24 hours of ische-mia: advantage of retrograde flush perfusion for preservation. Should lungs from donors with severe acute pulmonary embolism be accepted for transplantation? The Hannover experience. Early lung allograft function after retrograde and antegrade preservation. et al. Preimplantation retrograde pneumoplegia in clinical lung transplant-ation. Assessment of lungs for transplantation: a stepwise analysis of 476 donors. et al. Iloprost to improve surfactant function in porcine pulmonary grafts stored for twenty-four hours in low-potassium dextran solution. Unexpected donor pulmonary embolism affects early outcome after lung transplantation: a major mechanism of primary graft failure? J Thorac Amelioration of pulmonary allograft injury by administering a second rinse solution. De Leyn P, Coosemans W et al. Risk factors for airway complications within the first year after lung transplantation. Re: Retrograde in situ versus antegrade pulmonary preservation in clinical lung transplantation: a single-centre experience. Historically, grafts were preserved by means of autoperfusion with extracorporeal circulation, topical cooling or donor core cooling. In the 1980s, the standard lung preservation method was single pulmonary artery flush perfusion, using modified Euro-Collins solution at 4°C [1]. However, reperfusion injury remained a significant factor for morbidity and early mortality after lung transplant. Since the early years of lung preservation strategies, some advances have emerged in transplant teams, such as adding prostaglandin E2 to prevent counteract temperature and potassium-induced vasocon-striction. The use of low potassium dextran glucose solutions shows better overall lung function, superior early oxygenation, higher lung compliance, lower incidence of severe primary graft dysfunction and 30-day mortality [2]. As Gohrbandt et al. point out, the route to administer the preservation solution may also have an impact on early lung graft performance [3]. Anterograde flush initiating the infusion through the pulmonary artery with pulmonary vein drainage was the traditional approach for many years [4]. This technique, however, presents a number of limitations. Flushing the pulmonary artery leaves the bronchial tissue to be preserved by topical cooling alone, raising the complication from the bronchial suture. Also, clots and fat or brain tissue emboli, especially in donors with major trauma and B. Gohrbandt et al. / European Journal of Cardio-Thoracic Surgery 62