The present study was undertaken to clarify the effect of differences in the ionic composition of a preservation solution by investigating ultrastructures of pulmonary endothelial cells and oxygenation ability of preserved lungs after reperfusion. The relation between the ultrastructural changes and the oxygenation ability was also examined. Canine lungs flushed with an extracellular-type (ET)-Kyoto solution (group A, n = 6), with an intracellular-type-Kyoto solution and prostaglandin El (group B, n=6), or with Euro-Collins solution and prostaglandin E1 (group C, n=6) were stored at 4 degrees C for 20 hr. In transmission electron microscopic findings, the frequency of ultrastructural changes (protrusion of endothelial cells and cellular vacuolization) was significantly less in group A (23.3 +/- 9.1 and 13.3 +/- 5.2%, respectively) than in group B (64.4 +/- 6.1 and 42.2 +/- 8.8%, respectively). In group A, PaO2 after 40, 70, and 130 min of reperfusion was uniformly excellent (289.4 +/- 5.7, 303.3 +/- 7.0, and 303.0 +/- 19.6 mm Hg, respectively) and significantly higher than in groups B and C (202.6 +/- 32.0 and 185.9 +/- 23.0 mm Hg, respectively) after 70 min and higher than in group C (155.7 +/- 36.3 mm Hg) after 130 min of reperfusion. A negative correlation was noted between the frequency of cellular vacuolization and the PaO2 after reperfusion. These results indicated that extracellular ion composition has significantly better effect on pulmonary vascular ultrastructures than intracellular ion composition. This may be a factor making ET-Kyoto solution superior to the other two solutions in oxygenation ability after reperfusion. When attempting to develop better lung preservation solution, the ability to preserve the ultrastructures of preserved lung may be an important consideration in the evaluation.