Flush perfusion with low potassium dextran solution improves early graft function in clinical lung transplantation

Strüber, Martin; Wilhelmi, Michaela; Harringer, Wolfgang; Niedermeyer, J; Anssar, Marcel; Künsebeck, Anna; Schmitto, Jan D.; Haverich, Axel

doi:10.1016/s1010-7940(00)00631-x

Cited by 94 publications

(45 citation statements)

References 13 publications

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“…LPD single flush solution was also used for the last 34 lungs procured and transplanted into 24 patients of this study. There is considerable evidence from laboratory studies that LPD provides excellent lung preservation for up to 24 h and limits the extent of ischemic-reperfusion injury, especially when compared to EC [10,11]. Many clinical studies attempted to show a reduction in the occurrence of postlung transplant graft failure.…”

Section: Discussionmentioning

confidence: 99%

Aprotinin decreases reperfusion injury and allograft dysfunction in clinical lung transplantation☆

Bittner

Richter

Kuntze

et al. 2006

European Journal of Cardio-Thoracic Surgery

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Section: Discussionmentioning

confidence: 99%

Aprotinin decreases reperfusion injury and allograft dysfunction in clinical lung transplantation☆

Bittner

Richter

Kuntze

et al. 2006

European Journal of Cardio-Thoracic Surgery

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“…The mortality rate of 8%, caused by severe ischemia-reperfusion injuries, which was observed after the use of Euro-Collins solution was abolished [18]. This observation was confirmed by Keshavjee [19] and Haverich [20] and lead to a substitution of Euro Collins by LPD.…”

Section: Discussionmentioning

confidence: 74%

Improvement of Lung Preservation – From Experiment to Clinical Practice

Müller

Bittmann²,

Hatz³

et al. 2002

Eur Surg Res

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Background: Reperfusion injury represents a severe early complication following lung transplantation. Among the pathogenetic factors, the high potassium content of Euro-Collins^® 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^®: 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 AaDO₂ 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), paO₂ 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.

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“…A new preservation solution composed primarily of low potassium dextran (Perfadex1; Vitrolife, Gothenburg, Sweden) has also been developed specifically for the lung and has been implemented clinically by many centres over the past few years. Five clinical reports have compared the results of Perfadex1 to those of Euro-Collins1 (Baxter Healthcare Corp., Pharmacy Division, Deerfield, IL, USA) [27][28][29][30][31], and four of them observed significantly better lung function on arrival in the intensive care unit as well as a trend towards lower 30-day mortality and better 1-yr survival with Perfadex1 (table 1). An additional report demonstrated that after adjustment for graft ischaemic time, extracellulartype preservation solutions were associated with a decreased incidence of primary graft failure after lung transplantation when compared with intracellular-type preservation solutions such as Euro-Collins1 [32].…”

Section: Methods Of Lung Preservationmentioning

confidence: 99%

Strategies to increase limited donor resources

Perrot¹,

Weder²,

Patterson³

et al. 2004

Eur Respir J

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A number of strategies have been advocated to increase the number of lung donors including: 1) improvement in donor resuscitation; 2) better methods of lung preservation; 3) extension of the lung donor selection criteria; 4) development of a living-related lung donor programme; and 5) utilisation of nonheart beating donors.Other strategies such as the split-lung technique and techniques of lung reduction to accommodate large lungs into a small-size recipient have also been used successfully. In this article, each of these strategies have been reviewed and some recommendations are suggested based on the authors9 own experience and that of the literature.

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Flush perfusion with low potassium dextran solution improves early graft function in clinical lung transplantation

Abstract: A reduction of perioperative mortality and morbidity suggests that LPD solution has superior early graft function compared to lung preservation using EC solution.

Cited by 94 publications

References 13 publications

Aprotinin decreases reperfusion injury and allograft dysfunction in clinical lung transplantation☆

Aprotinin decreases reperfusion injury and allograft dysfunction in clinical lung transplantation☆

Improvement of Lung Preservation – From Experiment to Clinical Practice

Strategies to increase limited donor resources

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