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(reg) 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 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.

• Authors: C Müller, I Bittmann, R Hatz, B Kellner, G Schelling, H Fürst, B Reichart, F W Schildberg
• Journal: European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes (Eur Surg Res) 2002 Jan-Apr Vol. 34 Issue 1-2 Pg. 77-82 ISSN: 0014-312X [Print] Switzerland
• PMID: 11867906 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright 2002 S. Karger AG, Basel

Chemical References

• Dextrans
• Euro-Collins' solution
• Hypertonic Solutions
• Organ Preservation Solutions
• low potassium dextran glucose solution
• Glucose

Topics

• Adult
• Animals
• Dextrans (therapeutic use)
• Female
• Glucose (therapeutic use)
• Humans
• Hypertonic Solutions (therapeutic use)
• Lung (physiology)
• Lung Diseases (surgery)
• Lung Transplantation (methods)
• Male
• Middle Aged
• Organ Preservation Solutions (therapeutic use)
• Reperfusion Injury (drug therapy, mortality, prevention & control)
• Swine