Lung procurement by low-potassium dextran and the effect on preservation injury. Munich Lung Transplant Group.
BACKGROUND
This clinical study was performed to evaluate the effect of low-potassium dextran (LPD) solution on organ function in human lung transplantation.


METHODS
A total of 80 patients were included in this study. Donor lungs were flushed with Euro-Collins (EC) solution in 48 cases or LPD (Perfadex) in 32 cases. Subsequently, single- (EC: n = 31; LPD: n = 15) or double-lung transplantations (EC: n = 17; LPD: n = 17) were performed. The evaluation parameters of transplant function were the reperfusion injury score (grade I to V); the alveolar/arterial oxygen ratio; the duration of respirator therapy; and the length of intensive care treatment and survival.


RESULTS
Incidence and severity of reperfusion injury score were more severe in the EC group (31 of 48: grade I: n = 13; II: n = 8; III: n = 5; IV: n = 2; V: n = 3; LPD group: 17 of 32 patients; grade I: n = 12; II: n = 1; III: n = 3; IV: n = 0 grade V: n = 0), leading to death in three patients. In the LPD group, despite of the use of cardiopulmonary bypass, alveolar/arterial oxygen ratio values were significantly (P = 0.009) better during the early postoperative phase. Thirty-day mortality was 12% in the EC group and 6% in the LPD group. The one-year survival rate was 79% after the use of LPD (vs. EC: 62%).


CONCLUSIONS
Graft preservation using LPD leads to better immediate and intermediate graft function after pulmonary transplantation and also results in better long-term survival.
Müller
C
C
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, München, Germany. christian.mueller@gch.med.uni-muenchen.de
Fürst
H
H
Reichenspurner
H
H
Briegel
J
J
Groh
J
J
Reichart
B
B
D000328:Adult; D002315:Cardiopulmonary Bypass; D003911:Dextrans / Q000737:chemistry / Q000494:pharmacology*; D005260:Female; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000503:physiopathology; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000009:adverse effects*; D019188:Organ Preservation Solutions / Q000737:chemistry / Q000494:pharmacology*; D011188:Potassium / Q000008:administration & dosage* / Q000494:pharmacology; D013902:Radiography, Thoracic; D015427:Reperfusion Injury / Q000453:epidemiology / Q000503:physiopathology; D012720:Severity of Illness Index; D016019:Survival Analysis; D014019:Tissue Donors
D003911:Dextrans; D019188:Organ Preservation Solutions; D011188:Potassium