Late retrograde perfusion of donor lungs does not decrease the severity of primary graft dysfunction.
BACKGROUND
The ideal preservation strategy has yet to be established in lung transplantation. This clinical study compares primary graft dysfunction using antegrade and retrograde perfusion of donor lungs.


METHODS
Over a 6-year period, 153 consecutive patients underwent lung transplantation in our institution. Group I consists of 65 patients who received lungs preserved with an antegrade flush of modified Euro-Collins solution. Group II includes 65 patients who received lungs preserved with an antegrade flush of low-potassium dextran (LPD) solution. Group III consists of 23 patients who received lungs preserved with an antegrade and a preimplantation retrograde flush of LPD solution. Endpoints evaluated were the following: acute lung injury (ALI) score, time to achieve a fraction of inspired oxygen (Fio2) of 40% and a positive end-expiratory pressure (PEEP) of 5, length of ventilation, length of intensive care unit (ICU) stay, 90-day operative mortality, and patient survival rates.


RESULTS
The patient demographic data, underlying diagnosis, number of single and double lung transplants, use of cardiopulmonary bypass, and mean ischemic times were similar in all 3 groups. The mean ALI score (6.2, 5.8, and 6.0) and the median length of ventilation (23.5, 24.0, and 27.0 hours) in groups I, II, and III, respectively, were not significantly different. The length of ICU stay, the 90-day operative mortality, and the survival rates were not significantly different in the 3 groups.


CONCLUSIONS
Our results suggest that late retrograde perfusion of donor lungs does not decrease the severity of primary graft dysfunction when compared with standard antegrade techniques.
Ferraro
Pasquale
P
Service de Chirurgie Thoracique, Département de Chirurgie, Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada. pasquale.ferraro@umontreal.ca
Martin
Jocelyne
J
Dery
Julie
J
Prenovault
Julie
J
Samson
Louise
L
Coutu
Marianne
M
Chen
Long-Qi
LQ
Poirier
Charles
C
Noiseux
Nicolas
N
Duranceau
Andre
A
Berthiaume
Yves
Y
D000328:Adult; D015331:Cohort Studies; D003911:Dextrans / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology*; D006085:Graft Survival; D006801:Humans; D006982:Hypertonic Solutions / Q000494:pharmacology; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D010477:Perfusion / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
D003911:Dextrans; C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D019188:Organ Preservation Solutions