Scanning and transmission electron microscopy of human donor lungs: fine structure of the pulmonary parenchyma following preservation and ischemia.

In six cases of clinical single-lung transplantation, the contralateral donor lungs were studied by means of scanning (SEM) and transmission (TEM) electron microscopy. SEM and TEM revealed an overall good to excellent preservation of the pulmonary parenchyma. Since the donor double lung blocks, which were preserved by means of pulmonary arterial perfusion with modified Euro-Collins solution, were separated immediately prior to transplantation, transplanted and contralateral lungs had been subjected to identical influences. Comparing the arterial oxygenation achieved in the recipient 6 h after transplantation with the structural data of the corresponding contralateral donor lung, the degree of epithelial alterations appeared to be most important in determining postoperative lung function. Concerning the assessment of the quality of the alveolar epithelium, gradings performed independently by means of SEM and TEM yielded largely corresponding scores, while a significant shortcoming of SEM was the very limited access to the endothelial surface. Taking into account the relevance of epithelial injury in determining postoperative lung function, SEM can provide clinically relevant data more quickly than TEM. To quantify the fine structural alterations of human donor lungs, however, TEM-based morphometry is required.