Lung preservation and lung injury.

Lung preservation and its attendant ischemia-reperfusion injury is a complex phenomenon that begins with lung injury that may be present in the donor before any preservation intervention. Acute preservation interventions in common use include single-flush perfusion and donor core-cooling on cardiopulmonary bypass. From this moment forward the ischemia injury begins, and increases during the phase of organ storage. The lung continues to metabolize glucose even at these low temperatures, and future improvements may well lie in recognizing this requirement. With reperfusion, another phase of lung injury begins as the ischemic lung is overloaded with oxygen and oxygen free radicals are generated. Research efforts have focused on minimizing the effect of free-radicals at various steps along their formation and diminishing their interaction with cell membranes.