title: Effect of lung allograft ischaemia duration on postreperfusion graft function and postoperative course.
abstract: Lung transplantation is limited by the effects of ischaemia. Previous clinical studies related graft ischaemia duration to post-operative pulmonary function in the ICU, morbidity, and overall survival. This report describes the intraoperative pulmonary allograft function immediately after reperfusion. 23 lung transplantations (15 bilateral, 8 single) were analysed. Donor selection and organ procurement were identical. After pulmonary vasodilation with prostacyclin, allografts were flush-perfused with cold modified Euro-Collins solution. Mean duration of lung ischaemia was 255.1 +/- 35.1 min (190-314 min). Ischaemia times did not differ with respect to the recipient's disease or the use of extracorporeal circulation. After reperfusion, oxygenation indices deteriorated in 73.9% of patients compared with the native lungs (313.4 +/- 163.5 vs 427.2 +/- 96.1, p = 0.006). Linear regression analysis and subgroup analysis both revealed a significant influence of the duration of allograft ischaemia on early transplant function. Ischaemia of more than 4 hours resulted in an acceptable but significantly lower PaO2 (254.9 +/- 143.3 mmHg vs 463.0 +/- 149.2 mmHg, p = 0.011). However, mean time until extubation and time spent in the ICU were not affected. It is concluded that flush-perfusion of the lung with modified Euro-Collins solution provides reliable preservation of lung function up to four hours. Longer ischaemia, up to six hours, is followed by an acceptable but progressively reduced early transplant function.
authors.affiliation: Department of Anaesthesiology, Hannover Medical School, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bund
authors.forename: M
authors.initials: M
authors.lastname: Strüber
authors.forename: J
authors.initials: J
authors.lastname: Heine
authors.forename: K
authors.initials: K
authors.lastname: Jaeger
authors.forename: T
authors.initials: T
authors.lastname: Wahlers
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.forename: S
authors.initials: S
authors.lastname: Piepenbrock
mesh_terms: D000328:Adult; D003422:Critical Care; D005260:Female; D006801:Humans; D007511:Ischemia / Q000503:physiopathology*; D007902:Length of Stay; D008168:Lung / Q000098:blood supply*; D016040:Lung Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D015427:Reperfusion Injury / Q000503:physiopathology*; D014184:Transplantation, Homologous; D016896:Treatment Outcome