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Original Articles: General Thoracic

Late Retrograde Perfusion of Donor Lungs Does Not Decrease the Severity of Primary Graft Dysfunction

^a Service de Chirurgie Thoracique and Service de Chirurgie Cardiaque, Département de Chirurgie, Montréal, Quebec, Canada
^b Département de Radiologie, Montréal, Quebec, Canada
^c Service de Pneumologie, Département de Médecine, Centre de Recherche, Montréal, Quebec, Canada
^d Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada

Accepted for publication May 15, 2008.

^_* Address correspondence to Dr Ferraro, Service de Chirurgie Thoracique, Département de Chirurgie, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke Est, Suite D-8050, Montréal, QC, H2L 4M1, Canada (Email: pasquale.ferraro{at}umontreal.ca).

Background: The ideal preservation strategy has yet to be established in lung transplantation. This clinical study compares primary graft dysfunction using antegrade and retrograde perfusion of donor lungs.

Methods: Over a 6-year period, 153 consecutive patients underwent lung transplantation in our institution. Group I consists of 65 patients who received lungs preserved with an antegrade flush of modified Euro-Collins solution. Group II includes 65 patients who received lungs preserved with an antegrade flush of low-potassium dextran (LPD) solution. Group III consists of 23 patients who received lungs preserved with an antegrade and a preimplantation retrograde flush of LPD solution. Endpoints evaluated were the following: acute lung injury (ALI) score, time to achieve a fraction of inspired oxygen (FiO ₂) of 40% and a positive end-expiratory pressure (PEEP) of 5, length of ventilation, length of intensive care unit (ICU) stay, 90-day operative mortality, and patient survival rates.

Results: The patient demographic data, underlying diagnosis, number of single and double lung transplants, use of cardiopulmonary bypass, and mean ischemic times were similar in all 3 groups. The mean ALI score (6.2, 5.8, and 6.0) and the median length of ventilation (23.5, 24.0, and 27.0 hours) in groups I, II, and III, respectively, were not significantly different. The length of ICU stay, the 90-day operative mortality, and the survival rates were not significantly different in the 3 groups.

Conclusions: Our results suggest that late retrograde perfusion of donor lungs does not decrease the severity of primary graft dysfunction when compared with standard antegrade techniques.

Related Article

Invited Commentary

Federico Venuta and Marco Anile
Ann. Thorac. Surg. 2008 86: 1129-1130. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				M. Sugita, Y. Berthiaume, M. VanSpall, A. Dagenais, and P. Ferraro Pharmacologic modulation of alveolar liquid clearance in transplanted lungs by phentolamine and FK506. Ann. Thorac. Surg., September 1, 2009; 88(3): 958 - 964. [Abstract] [Full Text] [PDF]

				F. Venuta and M. Anile Invited Commentary Ann. Thorac. Surg., October 1, 2008; 86(4): 1129 - 1130. [Full Text] [PDF]