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J Thorac Cardiovasc Surg 2007;134:1313-1321
© 2007 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

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

UK Cardiothoracic Transplant Audit, Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom.

Received for publication August 10, 2006; revisions received March 9, 2007; accepted for publication May 11, 2007.

^_* Address for reprints: Robert S. Bonser, MD, FRCP, FRCS, FESC, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Edgbaston, Birmingham B15 2TH, United Kingdom. (Email: Robert.Bonser{at}uhb.nhs.uk).

Objective: Despite 50 years of lung preservation research, the optimal preservation technique is undefined. Using data from a national cohort, we investigated outcomes with different preservation methods after adult lung transplantation.

Methods: Early (30-day), late (30-day to 3-year), and overall (3-year) mortalities, adjusted for differences in donor and recipient characteristics, were compared by using Cox regression. Intensive care unit length of stay and the number of rejection episodes were secondary outcomes.

Results: Six hundred eighty-one eligible lung transplantations between July 1995 and June 2003 were preserved with Euro–Collins solution (n = 284), blood albumin (n = 139), core cooling (n = 107), or low potassium dextran solution (n = 151). There was significantly increased use of low potassium dextran solution over time (P < .001). Unadjusted 3-year survival was similar across the groups (P = .72), with the highest 3-year survival in the low potassium dextran group (62%; 95% confidence interval, 51%–72%) and the lowest in the blood albumin group (49%; 95% confidence interval, 39%–58%). Risk-adjusted early (P = .70), late (P = .27), and overall (P = .72) survival was similar across the groups and was not affected by ischemic time. Freedom from death caused by primary graft dysfunction was again highest in the low potassium dextran group (95%; 95% confidence interval, 90%–98%) and lowest in the blood albumin group (91%; 95% confidence interval, 85%–95%). There was no difference in intensive care unit length of stay. An increased incidence of rejection was apparent with increasing ischemic time (P = .067).

Conclusion: The methods of lung preservation in current use do not seem to affect early or midterm survival after transplantation, but increasing ischemic time might predispose to increased rejection.

This article has been cited by other articles:

				G. Thabut, Y. Castier, and H. Mal Does the method of lung preservation influence outcome after transplantation? An analysis of 681 consecutive procedures. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1408 - 1408. [Full Text] [PDF]

				J. S. Ganesh, C. A. Rogers, N. R. Banner, and R. S. Bonser Reply to the editor. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1408 - 1409. [Full Text] [PDF]