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Influence of preservation solution on early lung function (Euro-Collins vs Perfadex)
Influence of Preservation Solution on Early Lung Function (EuroCollins Vs Perfadex) J.M. Rabanal, A.M. Iban˜ez, R. Mons, A.M. Gonzalez, M. Carbajo, J. Ortega, and F. Zurbano ABSTRACT Background. This clinical study was performed to evaluate the efficiency of 2 different preservation solutions (Euro-Collins [EC] vs Perfadex [P]) on organ function in human lung transplantation. Methods. The donor lungs for 46 patients were flushed either with EC solution (25 cases, EC group) or Perfadex (21 cases, P group). Transplant function was assayed using PaO2/FiO2 ratio after transplantation upon intensive care unit (ICU) arrival and at 12 and 24 hours later (T1, T2, and T3, respectively). We also compared the duration of mechanical ventilatory support and ICU stay. Results. The PO2/FiO2 ratio was significantly better in the P than EC group at T1, T2, and T3. The duration of mechanical ventilatory support and ICU stay were lower also in P group, whereas age, sex, aetiology of lung disease, donor, PaO2/FiO2 ratio, and ischemia time did not show differences between the 2 groups. Conclusions. Our data on graft function tend to confirm better graft preservation using the P preservation solution.
L
UNG TRANSPLANTATION (LT) has gained widespread acceptance as a therapeutic option for a select number of patients with end-stage lung disease refractory to other forms of medical treatment.1 However, overall mortality after LT is still significant. Early graft failure after LT has been given various names, such as reimplantation edema, reperfusion edema, primary graft failure, or allograft dysfunction. The main mechanism underlying early graft failure is considered to be an ischemia/reperfusion injury, therefore, lung preservation seems to be key for initial graft function. The aim of this study was to assess the influence on early lung function of 2 different preservation solutions after LT. MATERIALS AND METHODS Between October 1997 and October 2002, 81 patients underwent single LT (SLT) or bilateral LT (BLT). To avoid the learning curve effects, we only included the last 46 transplant recipients. Recently a new extracellular-type low potassium dextran (LPD) preservation solution (Perfadex [P]) has been introduced clinically. We used this new preservation solution (P group) in the last 21 flushed donor organs. A control group (Euro-collins [EC] group) included 25 previously transplanted patients whose lungs were preserved with conventional intracellular solution (EC). For the purpose of this study, we analysed sex, age, etiology of lung disease, ischemic time, need for cardiopulmonary by-pass, type of LT (SLT or BLT), PaO2/fraction of inspired (FiO2) ratio in donor, PaO2/FiO2 in
recipient on arrival (ICU) (T1), at 12 hours (T2), and at 24 hours posttransplantation (T3) in the intensive care unit on total mechanical ventilation, ICU time, and survival at day 30. Statistical analyses were performed using standard parametric methods: analysis of variance plus Bonferroni post-test correction were performed with the GraphPad Instat software program.
RESULTS
The mean age (52 ⫾ 11 years, EC group, vs 53 ⫾ 9.1 years, P group), sex, etiology of lung disease, donor PaO2/FiO2 ratio (453 ⫾ 69, EC group, vs 460 ⫾ 73, P group), LT (SLT 10 and 15 BL, EC group, vs 8 SLT and 13 BLT, P group), and lung ischemia times first/second (288 ⫾ 67 and 312 ⫾ 22, EC group, vs 259 ⫾ 88 and 331 ⫾ 36, P group min.) were comparable between the 2 groups. The PaO2/FiO2 ratio was significantly better among the P than the EC group at T1 (310 ⫾ 150 vs 170 ⫾ 102; P ⬍ From the Departments of Anesthesiology (I.M.R, A.M.I, A.M.G.), Thoracic Surgery (R.M, M.C, J.O.), and Pneumology (F.Z), Hospital Universitario Marque´s de Valdecilla, Santander, Spain. Address reprint requests to J.M. Rabanal Department of Anesthesia-Reanimation (Lung Transplantation Unit), Hospital Universitario Marque´s de Valdecilla, Santander 39008, Spain.
0041-1345/03/$–see front matter doi:10.1016/S0041-1345(03)00690-0
© 2003 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
1938
Transplantation Proceedings, 35, 1938 –1939 (2003)
EARLY LUNG FUNCTION
.05), T2 (335 ⫾ 130 vs 236 ⫾ 101; P ⬍ .05), and T3 (321 ⫾ 111 vs 271 ⫾ 103; P ⬍ .05). Time on mechanical ventilation was significantly shorter among the P than the EC group (72 ⫾ 74 vs 92 ⫾ 91; P ⬍ .05). Survival rate at day 30 was 100% in the P and 88% in the EC group. CONCLUSIONS
Compared with EC graft preservation with LPD (P) demonstrated improved lung function in the early phase after
1939
clinical LT. This superior outcome with LPD is consistent with evidence from experimental and other clinical studies.2,3 REFERENCES 1. Arcasoy SM, Kotloff RM: N Engl J Med 340:1081, 1999 2. Thabut G, Vinater I, Brugiere O, et al: Am J Respir Crit Care Med 164:1204, 2001 3. Mu ¨ller C, Furst H, Reichenspurner H, et al: Transplantation 68:1139, 1999
L
UNG TRANSPLANTATION (LT) has gained widespread acceptance as a therapeutic option for a select number of patients with end-stage lung disease refractory to other forms of medical treatment.1 However, overall mortality after LT is still significant. Early graft failure after LT has been given various names, such as reimplantation edema, reperfusion edema, primary graft failure, or allograft dysfunction. The main mechanism underlying early graft failure is considered to be an ischemia/reperfusion injury, therefore, lung preservation seems to be key for initial graft function. The aim of this study was to assess the influence on early lung function of 2 different preservation solutions after LT. MATERIALS AND METHODS Between October 1997 and October 2002, 81 patients underwent single LT (SLT) or bilateral LT (BLT). To avoid the learning curve effects, we only included the last 46 transplant recipients. Recently a new extracellular-type low potassium dextran (LPD) preservation solution (Perfadex [P]) has been introduced clinically. We used this new preservation solution (P group) in the last 21 flushed donor organs. A control group (Euro-collins [EC] group) included 25 previously transplanted patients whose lungs were preserved with conventional intracellular solution (EC). For the purpose of this study, we analysed sex, age, etiology of lung disease, ischemic time, need for cardiopulmonary by-pass, type of LT (SLT or BLT), PaO2/fraction of inspired (FiO2) ratio in donor, PaO2/FiO2 in
recipient on arrival (ICU) (T1), at 12 hours (T2), and at 24 hours posttransplantation (T3) in the intensive care unit on total mechanical ventilation, ICU time, and survival at day 30. Statistical analyses were performed using standard parametric methods: analysis of variance plus Bonferroni post-test correction were performed with the GraphPad Instat software program.
RESULTS
The mean age (52 ⫾ 11 years, EC group, vs 53 ⫾ 9.1 years, P group), sex, etiology of lung disease, donor PaO2/FiO2 ratio (453 ⫾ 69, EC group, vs 460 ⫾ 73, P group), LT (SLT 10 and 15 BL, EC group, vs 8 SLT and 13 BLT, P group), and lung ischemia times first/second (288 ⫾ 67 and 312 ⫾ 22, EC group, vs 259 ⫾ 88 and 331 ⫾ 36, P group min.) were comparable between the 2 groups. The PaO2/FiO2 ratio was significantly better among the P than the EC group at T1 (310 ⫾ 150 vs 170 ⫾ 102; P ⬍ From the Departments of Anesthesiology (I.M.R, A.M.I, A.M.G.), Thoracic Surgery (R.M, M.C, J.O.), and Pneumology (F.Z), Hospital Universitario Marque´s de Valdecilla, Santander, Spain. Address reprint requests to J.M. Rabanal Department of Anesthesia-Reanimation (Lung Transplantation Unit), Hospital Universitario Marque´s de Valdecilla, Santander 39008, Spain.
0041-1345/03/$–see front matter doi:10.1016/S0041-1345(03)00690-0
© 2003 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
1938
Transplantation Proceedings, 35, 1938 –1939 (2003)
EARLY LUNG FUNCTION
.05), T2 (335 ⫾ 130 vs 236 ⫾ 101; P ⬍ .05), and T3 (321 ⫾ 111 vs 271 ⫾ 103; P ⬍ .05). Time on mechanical ventilation was significantly shorter among the P than the EC group (72 ⫾ 74 vs 92 ⫾ 91; P ⬍ .05). Survival rate at day 30 was 100% in the P and 88% in the EC group. CONCLUSIONS
Compared with EC graft preservation with LPD (P) demonstrated improved lung function in the early phase after
1939
clinical LT. This superior outcome with LPD is consistent with evidence from experimental and other clinical studies.2,3 REFERENCES 1. Arcasoy SM, Kotloff RM: N Engl J Med 340:1081, 1999 2. Thabut G, Vinater I, Brugiere O, et al: Am J Respir Crit Care Med 164:1204, 2001 3. Mu ¨ller C, Furst H, Reichenspurner H, et al: Transplantation 68:1139, 1999