Improvement of lung preservation - From experiment to clinical practice

Background. Reperfusion injury represents a severe early
complication following lung transplantation. Among the pathogenetic
factors, the high potassium content of Euro-Collins(R) solution is
discussed. Material and Methods: In a pig model of orthotopic
left-sided lung transplantation we investigated the effect of
Euro-Collins solution (EC: n=6) versus low potassium dextran (LPD:
Perfadex(R): n = 6). Sham-operated (n = 6) animals served as
control. Transplant function, cellular energy metabolism and
endothelial morphology served as parameters. In a clinical
investigation, 124 patients were evaluated following single (EC: n
= 31; LPD n = 37) or double (EC: n = 17; LPD n = 39) lung
transplantation, whose organs where preserved with EC (n = 48) or
LPD (n = 76). Duration of ischemia, duration of ventilation and
stay on ICU were registered. Primary transplant function was
evaluated according to AaDO(2) values. Cause of early death (30
days) was declared. Results: Experimental results: After flush with
EC and 18 h ischemia, a reduction of tissue ATP content (p <
0.01 vs inital value and LPD) was noted. Endothelial damage after
ischemia was severe (p < 0.05 vs control), paO(2) was
significantly decreased. Clinical results: In the LPD group,
duration of ischemia was longer for the grafts transplanted first
(SLTx and DLTx: p = 0.0009) as well as second (2. organ DLTx: p =
0.045). Primary transplant function was improved (day 0: SLTx: p =
0.0015; DLTx: p = 0.0095, both vs EC). Duration of ventilation and
stay on ICU were shorter (n.s.). Reperfusion injury-associated
death was reduced from 8% (EC) to 0 (LPD). Conclusion: In
experimental lung preservation, LPD lead to an improved graft
function. These results were confirmed in clinical lung
transplantation. Clinical lung preservation, therefore, should be
carried out by use of LPD. Copyright (C) 2002 S. Karger AG, Basel.