Early outcomes comparing Perfadex, Euro-Collins, and Papworth solutions in lung transplantation.
BACKGROUND
Despite improved surgical techniques and medical management, primary graft dysfunction (PGD) remains a major cause of early morbidity and mortality after lung transplantation. Different types of lung preservation solutions have been developed and applied to clinical use; however, the relative clinical efficacy of these solutions to prevent PGD remains controversial. This study aimed to investigate the effect of the three solutions most commonly used (Perfadex [Vitrolife, Göteborg, Sweden], Papworth, and Euro-Collins [Baxter Healthcare, Old Toongabbie NSW, Australia]) on posttransplant outcomes.


METHODS
Early outcomes from 157 consecutive lung transplants (113 bilateral and 44 single) performed at The Alfred Hospital were compared across three preservation solutions.


RESULTS
Posttransplant oxygenation (p = 0.57), pulmonary vascular resistance (p = 0.34), intubation hours (p = 0.66), intensive care unit days (p = 0.34), severe PGD (grade 3) (p = 0.70), 30-day mortality (p = 0.87), and 3-month % predicted forced expiratory volume in 1 second (p = 0.58) were not statistically different; however, Perfadex trended toward superiority among the three solutions. After adjustment of donor, recipient, and operative factors in multivariate analysis, Perfadex was significantly associated with the prevention of moderate to severe PGD (grade 2 to 3) at 48 hours posttransplant (odds ratio = 0.26 [0.10 to 0.72], p < 0.01) compared with Papworth (odds ratio = 0.75 [0.32 to 1.75], p = 0.51) and Euro-Collins (reference) solutions.


CONCLUSIONS
Although any advantageous effects of Perfadex on early posttransplant outcomes were generally subtle and statistically nonsignificant, Perfadex prevented moderate to severe PGD. Switching preservation solution from Euro-Collins (or Papworth) to Perfadex would appear to usefully contribute to a strategy to reduce PGD in lung transplantation.
Oto
Takahiro
T
Heart and Lung Transplant Unit, The Alfred Hospital, Melbourne, Australia.
Griffiths
Anne P
AP
Rosenfeldt
Franklin
F
Levvey
Bronwyn J
BJ
Williams
Trevor J
TJ
Snell
Gregory I
GI
D000328:Adult; D002951:Citrates; D005260:Female; D006801:Humans; D006982:Hypertonic Solutions; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D019188:Organ Preservation Solutions; D014021:Tissue Preservation / Q000379:methods*; D016896:Treatment Outcome
D002951:Citrates; C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D019188:Organ Preservation Solutions; C070005:Perfadex