JAMES D. HARDY 
335 
came clear that effective preservation of the 
graft while it was anoxic was the most crucial 
step in the technique of one-stage replantation 
of both lungs. The quality of the function of 
the replanted lung depended upon the rapidity 
and uniformity with which it was cooled. The 
most rapid and uniform cooling of the lungs was 
achieved by the infusion of lactated Ringer's 
solution through the pulmonary artery, in con- 
trast to earlier usage of the colloid dextran. 
Incidentally, it was our conclusion that the re- 
latively poor function of the second lung trans- 
plant which we performed in man was due to 
lung replantation and immediate right pulmonary 
ligation. 
edema within the first weeks coincided with 
the usual time of lymphatic regeneration. Sub- 
normal P02 values were frequently noted in 
the first two weeks, but these values returned to 
normal with the disappearance of pulmonary 
edema on chest roentgenogram. 
Workers in the field of lung transplantation 
had commonly believed that the canine lung 
would readily tolerate several hours of ischemia 
when cold. However, this view had been based 
on unilateral (or staged bilateral) replantation 
experiments in which the reversible but signifi- 
cant damage that the graft suffers during 
hypoxic transfer was not necessarily detrimen- 
tal to the animal, since the other lung remained 
intact. In contrast, when the life of the animal 
was dependent solely on replanted pulmonary 
tissue, as in our current experiments, it be- 
DOG # II 
Lt REPLANT + RPA LIGATION 
JAN. 13/70 
6 WEEKS POST- OP 
Figure 10. — Lung scan in Dog #11 (see Figure 9) six 
weeks after operation. 
