title: Late retrograde perfusion of donor lungs does not decrease the severity of primary graft dysfunction.
abstract: 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.
authors.affiliation: Service de Chirurgie Thoracique, Département de Chirurgie, Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada. pasquale.ferraro@umontreal.ca
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Martin
authors.forename: Julie
authors.initials: J
authors.lastname: Dery
authors.forename: Julie
authors.initials: J
authors.lastname: Prenovault
authors.forename: Louise
authors.initials: L
authors.lastname: Samson
authors.forename: Marianne
authors.initials: M
authors.lastname: Coutu
authors.forename: Long-Qi
authors.initials: LQ
authors.lastname: Chen
authors.forename: Charles
authors.initials: C
authors.lastname: Poirier
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noiseux
authors.forename: Andre
authors.initials: A
authors.lastname: Duranceau
authors.forename: Yves
authors.initials: Y
authors.lastname: Berthiaume
mesh_terms: 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
chemical_list: D003911:Dextrans; C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D019188:Organ Preservation Solutions