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Retrograde in situ versus antegrade pulmonary preservation in clinical lung transplantation: a single-centre experience

OBJECTIVE: Experimental and clinical studies have indicated a beneficial effect of retrograde lung preservation on post-transplant results. Accordingly, we conducted a non-randomized trial. METHODS: A total of 209 consecutive recipients transplanted with low-potassium dextrane (LPD)-preserved lungs were eligible for analysis. Antegrade lung preservation (AP) was performed in 173 patients and retrograde in situ perfusion (RP) in 36 patients using low-potassium dextrane solution in all cases. The prostacycline was added to preservation solution. RESULTS: The main donor, graft and recipient characteristics did not differ significantly between groups. There was a beneficial trend toward improved oxygenation indices in the RP cohort within the initial 48 post-transplant hours. The incidence of severe primary graft dysfunction was comparable up to 48 h post-transplant and was significantly increased in the RP cohort 72 h post-transplant (2.2% AP vs 14.8% RP, P = 0.016). Fatal bronchial dehiscences occurred more often in RP recipients (5.6% RP vs 0.6% AP, P = 0.067). The occurrence of bronchial stenoses revealed a slightly improved trend in the RP group (24.9% AP vs 13.9% RP, P = 0.218). Survival (P = 0.927) and bronchiolitis obliterans syndrome-free survival (P = 0.337) were comparable between groups. CONCLUSION: In our clinical survey, this analysis does not confirm the beneficial results of retrograde lung preservation alone, as was previously observed in experimental studies.

  • Gohrbandt, B.; Warnecke, G.; Fischer, S.; Simon, A. R.; Gottlieb, J.; Niehaus, A.; Bothig, D.; Haverich, A.; Strueber, M.

Keywords

  • Adult
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • Humans
  • Kaplan-Meier Estimate
  • Lung Transplantation/adverse effects/*methods/*mortality
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Organ Preservation/*methods
  • Organ Preservation Solutions/*pharmacology
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Survival Analysis
  • Time Factors
  • Tissue Donors
  • Treatment Outcome
  • Airway complication
  • BOS-free survival
  • Lung transplantation
  • Primary graft dysfunction
  • Retrograde lung preservation
Publication details
DOI: 10.1093/ejcts/ezv108
Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Pages: 55-62 
Number: 1
Work Type: Original
Location: BREATH
Disease Area: ELD
Partner / Member: MHH
Access-Number: 25881588
See publication on PubMed
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