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449: Celsior for Graft Preservation in Clinical Lung Transplantation
S222
Abstracts
The Journal of Heart and Lung Transplantation February 2008
nary hypertension, donor age & D:R gender match. Model discrimination was compared using the c-statistic. Results: 80% of transplants (10th-90thcentiles) had H, W, HW & BSA ratios between 0.96-1.09, 0.77-1.23, 0.77-1.28 & 0.89-1.13 respectively for male donor HTx & 0.91-1.06, 0.76-1.27, 0.72-1.28 & 0.87-1.13 respectively for female donor HTx. Corresponding median ratios were 1.02, 0.98, 0.99 & 1.00 for male donor HTx & 0.99, 0.97, 0.95 & 0.99 for female donor HTx. 30-day mortality was similar across quintiles of size match for all measures. This was unchanged on multivariate analysis; each model had only moderate ability to discriminate between survivors & non-survivors (c-statistic 0.61, 0.60, 0.61 & 0.62 for H, W, HW and BSA ratio models respectively). Conclusions: All size measures provided similar results. No differences in early mortality by size mismatch were found, which may be partly due to the avoidance of extreme size mismatches in this cohort. Therefore the limits of D:R size matching have not been defined, but the data suggest that any of the measures could be used to inform the decision making process. % 30-day mortality Size match measure
Quintile of size ratio 1 2 3
4
5
H W HW BSA
11.9 10.7 11.9 12.4
11.6 9.9 12.5 15.0
11.2 10.9 8.3 7.7
8.9 13.5 13.7 12.2
14.5 13.3 12.0 11.0
p-value 0.34 0.55 0.33 0.10
449 Celsior for Graft Preservation in Clinical Lung Transplantation B. Gohrbandt,1 A.R. Simon,1 S. Fischer,1 C. Hagl,1 J. Gottlieb,2 T. Welte,2 A. Haverich,1 M. Strueber,1 1Department of Cardiothoracic, Transplantation and Vascular Surgery, Medical School Hannover, Hannover, Germany; 2Department of Respiratory Medicine, Medical School Hannover, Hannover, Germany Purpose: Even after introduction of LPD-based lung graft preservation, ischemia-reperfusion injury remains to be a major contributor to early post-transplant mortality following lung transplantation (LTx). After favourable experimental data, Celsior solution was used in our clinical LTX program for graft preservation. Here we report the early outcome after clinical LTx comparing LPD with Celsior graft preservation. Methods and Materials: All data were prospectively recorded and retrospectively analyzed. A cohort of 241 consecutive human lung grafts was flush preserved with Celsior since January 2005. This group was compared with 161 patients receiving LPD preserved grafts prior to our switch to Celsior. Main endpoints included post-LTx PaO2/FiO2 ratio at different time points, post-Tx ventilation time, ICU-stay and 30- and 90 day mortality. Ratios of gender, urgency status, procedure and age were comparable in both groups. Results: Initial PaO2/FiO2 ratio on ICU (Celsior 334⫾133, LPD 263⫾154, p⫽0.03) was favourable in the Celsior group. After 24 hours graft function was comparable. Mean duration of mechanical ventilation was significantly shorter in the Celsior cohort (128⫾294 vs. 181⫾471 hrs, p⫽0.02). The length of ICU-stay was comparable in the Celsior group (11⫾18.5 days vs. 12.9⫾20.3 days LPD). The 30-day survival was 92.8% in the Celsior group vs. 88.2% in the LPD-cohort (p⫽0.05). 90-days survival was 86,4% in the Celsior group and 81,4% (p⫽ 0.05) in the LPD era. Conclusions: Human lung graft preservation by Celsior solution is at least as safe and effective as the LPD based solution in the clinical setting. This study underlines the beneficial effects of Celsior solution seen in experimental lung transplantation also in the clinical use. Further investigations as well as controlled trials are needed to
investigate the long term effect of Celsior compared to current standard preservation strategies.
450 The Successful Introduction of Donor Care Physiologists into Intra-Operative Management of Multi-Organ Donors F. Falter,1 A.M. Ingle,1 M. Goddard,3 G. Betts,2 K. Glodsmith,4 S. Tsui,2 1Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom; 2Transplant Unit, Papworth Hospital, Cambridge, United Kingdom; 3 Department of Pathology, Papworth Hospital, Cambridge, United Kingdom; 4R&D Department, Papworth Hospital, Cambridge, United Kingdom Purpose: The care of brain-stem dead organ donors is demanding and has traditionally been the responsibility of medically qualified personnel. We introduced a program of Donor Care Physiologists (DCP) in which non-medically qualified staff were trained to manage multiorgan donors during organ procurement. After a training period of 12 month Donor Care Physiologists (DCP) were introduced into the retrieval team as substitute for senior anaesthetic trainees. This study assesses the effectiveness of DCPs during multi-organ retrievals. Methods and Materials: Multi-organ donors were exclusively cared for by anaesthetic trainees between September 2001 and August2003 (Period A); the DCPs were shadowed and trained by anaesthetists between September 2003 and August 2004; qualified DCPs exclusively managed the donors between September 2004 and August 2006 (Period B). Recipient outcome data including 30 day mortality and length of stay (LOS) in the Intensive Care Unit (ICU) were collected prospectively. A multiple logistic regression analysis was used to compare Groups A and B. The model was adjusted for donor age, gender, cause of death, donor organ ischaemic time, use of inotropes in the donor and recipient gender and diagnosis. Results: There were 145 first-time heart transplants, 71 in Group A and 74 in Group B. There were no statistically significant differences in 30-day mortality or length of stay in the ICU between both periods (Table1). Conclusions: There is no significant difference in heart transplant recipient outcome between donors managed by senior anaesthetic trainees and DCPs. DCPs offer a clinically safe alternative to medically trained staff in providing intra-operative management of organ donors.
Table 1 30 day mortality Time period only Time period adjusted LOS in ICU ⱖ 3 days Time period only Time period adjusted
OR (95% CI)
p-value
0.82 (0.28, 2.40) 0.64 (0.20, 2.06)
0.72 0.46
1.97 (1.00, 3.89) 1.95 (0.90, 4.22)
0.05 0.09
451 Endothelial Dysfunction after Long Term Cold Storage in HTK Organ Preserving Solutions – Effects of Iron Chelators T. Radovits,1 J. Zotkina,1 L.-N. Lin,1 A. Koch,1 U. Rauen,2 M. Karck,1 G. Szabo ´ ,1 1Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany; 2Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany
Abstracts
The Journal of Heart and Lung Transplantation February 2008
nary hypertension, donor age & D:R gender match. Model discrimination was compared using the c-statistic. Results: 80% of transplants (10th-90thcentiles) had H, W, HW & BSA ratios between 0.96-1.09, 0.77-1.23, 0.77-1.28 & 0.89-1.13 respectively for male donor HTx & 0.91-1.06, 0.76-1.27, 0.72-1.28 & 0.87-1.13 respectively for female donor HTx. Corresponding median ratios were 1.02, 0.98, 0.99 & 1.00 for male donor HTx & 0.99, 0.97, 0.95 & 0.99 for female donor HTx. 30-day mortality was similar across quintiles of size match for all measures. This was unchanged on multivariate analysis; each model had only moderate ability to discriminate between survivors & non-survivors (c-statistic 0.61, 0.60, 0.61 & 0.62 for H, W, HW and BSA ratio models respectively). Conclusions: All size measures provided similar results. No differences in early mortality by size mismatch were found, which may be partly due to the avoidance of extreme size mismatches in this cohort. Therefore the limits of D:R size matching have not been defined, but the data suggest that any of the measures could be used to inform the decision making process. % 30-day mortality Size match measure
Quintile of size ratio 1 2 3
4
5
H W HW BSA
11.9 10.7 11.9 12.4
11.6 9.9 12.5 15.0
11.2 10.9 8.3 7.7
8.9 13.5 13.7 12.2
14.5 13.3 12.0 11.0
p-value 0.34 0.55 0.33 0.10
449 Celsior for Graft Preservation in Clinical Lung Transplantation B. Gohrbandt,1 A.R. Simon,1 S. Fischer,1 C. Hagl,1 J. Gottlieb,2 T. Welte,2 A. Haverich,1 M. Strueber,1 1Department of Cardiothoracic, Transplantation and Vascular Surgery, Medical School Hannover, Hannover, Germany; 2Department of Respiratory Medicine, Medical School Hannover, Hannover, Germany Purpose: Even after introduction of LPD-based lung graft preservation, ischemia-reperfusion injury remains to be a major contributor to early post-transplant mortality following lung transplantation (LTx). After favourable experimental data, Celsior solution was used in our clinical LTX program for graft preservation. Here we report the early outcome after clinical LTx comparing LPD with Celsior graft preservation. Methods and Materials: All data were prospectively recorded and retrospectively analyzed. A cohort of 241 consecutive human lung grafts was flush preserved with Celsior since January 2005. This group was compared with 161 patients receiving LPD preserved grafts prior to our switch to Celsior. Main endpoints included post-LTx PaO2/FiO2 ratio at different time points, post-Tx ventilation time, ICU-stay and 30- and 90 day mortality. Ratios of gender, urgency status, procedure and age were comparable in both groups. Results: Initial PaO2/FiO2 ratio on ICU (Celsior 334⫾133, LPD 263⫾154, p⫽0.03) was favourable in the Celsior group. After 24 hours graft function was comparable. Mean duration of mechanical ventilation was significantly shorter in the Celsior cohort (128⫾294 vs. 181⫾471 hrs, p⫽0.02). The length of ICU-stay was comparable in the Celsior group (11⫾18.5 days vs. 12.9⫾20.3 days LPD). The 30-day survival was 92.8% in the Celsior group vs. 88.2% in the LPD-cohort (p⫽0.05). 90-days survival was 86,4% in the Celsior group and 81,4% (p⫽ 0.05) in the LPD era. Conclusions: Human lung graft preservation by Celsior solution is at least as safe and effective as the LPD based solution in the clinical setting. This study underlines the beneficial effects of Celsior solution seen in experimental lung transplantation also in the clinical use. Further investigations as well as controlled trials are needed to
investigate the long term effect of Celsior compared to current standard preservation strategies.
450 The Successful Introduction of Donor Care Physiologists into Intra-Operative Management of Multi-Organ Donors F. Falter,1 A.M. Ingle,1 M. Goddard,3 G. Betts,2 K. Glodsmith,4 S. Tsui,2 1Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom; 2Transplant Unit, Papworth Hospital, Cambridge, United Kingdom; 3 Department of Pathology, Papworth Hospital, Cambridge, United Kingdom; 4R&D Department, Papworth Hospital, Cambridge, United Kingdom Purpose: The care of brain-stem dead organ donors is demanding and has traditionally been the responsibility of medically qualified personnel. We introduced a program of Donor Care Physiologists (DCP) in which non-medically qualified staff were trained to manage multiorgan donors during organ procurement. After a training period of 12 month Donor Care Physiologists (DCP) were introduced into the retrieval team as substitute for senior anaesthetic trainees. This study assesses the effectiveness of DCPs during multi-organ retrievals. Methods and Materials: Multi-organ donors were exclusively cared for by anaesthetic trainees between September 2001 and August2003 (Period A); the DCPs were shadowed and trained by anaesthetists between September 2003 and August 2004; qualified DCPs exclusively managed the donors between September 2004 and August 2006 (Period B). Recipient outcome data including 30 day mortality and length of stay (LOS) in the Intensive Care Unit (ICU) were collected prospectively. A multiple logistic regression analysis was used to compare Groups A and B. The model was adjusted for donor age, gender, cause of death, donor organ ischaemic time, use of inotropes in the donor and recipient gender and diagnosis. Results: There were 145 first-time heart transplants, 71 in Group A and 74 in Group B. There were no statistically significant differences in 30-day mortality or length of stay in the ICU between both periods (Table1). Conclusions: There is no significant difference in heart transplant recipient outcome between donors managed by senior anaesthetic trainees and DCPs. DCPs offer a clinically safe alternative to medically trained staff in providing intra-operative management of organ donors.
Table 1 30 day mortality Time period only Time period adjusted LOS in ICU ⱖ 3 days Time period only Time period adjusted
OR (95% CI)
p-value
0.82 (0.28, 2.40) 0.64 (0.20, 2.06)
0.72 0.46
1.97 (1.00, 3.89) 1.95 (0.90, 4.22)
0.05 0.09
451 Endothelial Dysfunction after Long Term Cold Storage in HTK Organ Preserving Solutions – Effects of Iron Chelators T. Radovits,1 J. Zotkina,1 L.-N. Lin,1 A. Koch,1 U. Rauen,2 M. Karck,1 G. Szabo ´ ,1 1Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany; 2Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany