Single orthotopic rat lung isografts were carried out in adult male AS rats after 48-hour cold storage (0 degrees C). Grafts were preserved by simple organ flush followed by low-temperature immersion. Hypertonic citrate (HCA) without additives was evaluated as the basic flush solution. In other groups desferrioxamine (an iron chelator), verapamil (a calcium channel blocker) and prostacyclin (PGI2) were added separately to HCA and given intravenously to donor and recipient animals in an attempt to improve the preservation. Baseline controls were fresh HCA-flushed lungs grafted immediately after harvest. Negative controls to the HCA assessment were lungs flushed with isotonic saline (NaCl) stored for 48 hr at 0 degrees C. Functional studies were carried out at weekly intervals until sacrifice (in the fifth postoperative week) and included assessment of blood flow, aeration and gas transfer by perfusion scintigraphy, chest roentgenograms, and blood gas analysis. Of the baseline control animals, 10/10 survived to the end of the study period; all grafts appeared macroscopically normal and blood gas analysis showed good function. Of the animals grafted with HCA-flushed, 48-hr-stored lungs 2/10 died postoperatively; 7/10 grafts appeared macroscopically normal at the end of the study, and one was slightly reduced in size. Blood gas analysis of HCA-flushed, 48-hr-stored lungs showed function similar to that of baseline control grafts. NaCl-flushed lungs (negative controls) survived surprisingly well: 3/10 animals died postoperatively, 6/10 lungs appeared normal, and one was reduced in size. Assessment of graft function showed no significant benefit of HCA flush compared with NaCl. Treatment with desferrioxamine, verapamil or prostacyclin (PGI2) failed to improve the outcome after HCA flush; in fact desferrioxamine gave significantly poorer results. The study has shown that successful 48-hr preservation of rat lung isografts can be achieved by simple organ flush with HCA and storage at 0 degrees C. Contrary to expectation and experience with preservation of other organs, rat lungs were remarkably well preserved after flush with NaCl.