Improvement of Lung Preservation – From Experiment to Clinical Practice

Abstract

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.

Experimental lung preservation with perfadex: effect of the no-donor nitroglycerin on postischemic outcome

“…This approach could represent an easily applicable tool in clinical lung transplantation and has the potential to further improve the excellent results of lung preservation with PER, which has gained increased worldwide acceptance in recent years. 36,37 We gratefully acknowledge the expert technical assistance of S. Kirste, A. Apel, S. Freese, A. Gerken, H. Hühn, and M. Kirste.…”

PDE-5 inhibitor donor intravenous preconditioning is superior to supplementation in standard preservation solution in experimental lung transplantation☆

“…Optimizing preservation in lung transplantation is still a major directive in research when considering the high occurrence of ischemia/reperfusion injury, following reperfusion edema in up to 50-60% in the literature [1] and with a mortality of up to 20% [2].…”

“…As standard preservation solution we used buffered lowpotassium dextran (LPD) solution which is used clinically with superior results when compared to other preservation solutions [1,9,10].…”

Does the method of lung preservation influence outcome after transplantation? An analysis of 681 consecutive procedures

“…[3][4][5][6][7] However, comparison of outcomes with LPD solution versus other conventional preservation techniques in the literature reveals varying results. [7][8][9][10] Despite 5 decades of clinical and laboratory research evaluating methods of lung preservation, [11][12][13] there have been few studies examining the effect of preservation technique on survival after LTx. To identify differences, if any, in outcomes with current lung preservation techniques, we analyzed data from the United Kingdom Cardiothoracic Transplant Audit (UKCTA).…”