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J Thorac Cardiovasc Surg 2006;131:218-223
© 2006 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Modified reperfusion in clinical lung transplantation: The results of 100 consecutive cases

^a Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Calif
^b Division of Pulmonary Medicine, Critical Care and Hospitalists, David Geffen School of Medicine, University of California, Los Angeles, Calif.

Received for publication April 21, 2005; revisions received August 15, 2005; accepted for publication August 30, 2005.

^_* Address for reprints: Gabriel T. Schnickel, MD, Division of Cardiothoracic Surgery, 62-182 CHS, UCLA Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90095. (Email: gschnick{at}ucla.edu).

OBJECTIVE: Severe primary graft dysfunction occurs in 10% to 20% of lung transplant recipients and is the leading cause of early death after lung transplantation. We hypothesized that altering the content of the initial reperfusate and maintaining a low reperfusion pressure after surgical implantation would lead to a low incidence of primary graft dysfunction.

METHODS: We analyzed the records of all patients who underwent lung transplantation at our institution from March 1, 2000, to August 30, 2004. The modified reperfusion technique involved the insertion of a catheter into the main or individual pulmonary artery after implantation. The recipient blood was depleted of leukocytes; supplemented with nitroglycerin; adjusted for pH and calcium level; enriched with aspartate, glutamate, and dextrose; and then administered into the pulmonary arteries of the newly transplanted lung(s) for the first 10 minutes of reperfusion. Severe primary graft dysfunction was defined as a PaO ₂/inspired oxygen fraction of less than 150 with diffuse infiltrate on the radiograph in absence of other causes.

RESULTS: During this interval, 100 patients underwent lung transplantation with the modified reperfusion technique. Forty-two patients underwent single-lung transplantation, of which 5 patients required cardiopulmonary bypass for the procedure. Fifty-eight patients underwent double-lung transplantation; all double-lung transplantation procedures were performed with patients on cardiopulmonary bypass. There were no technical complications associated with the modified reperfusion. The mean PaO ₂/inspired oxygen fraction at 6 hours in this cohort was 252 ± 123 mm Hg. The median number of days on the ventilator was 2. More importantly, the incidence of severe primary graft dysfunction in this cohort was 2.0%. The early survival (30-day or in-hospital mortality) of this group of patients was 97%.

CONCLUSIONS: The technique of modified reperfusion in human lung transplantation is associated with a low incidence of severe primary graft dysfunction and favorable short-term outcomes.

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