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J Thorac Cardiovasc Surg 2001;121:594-596
© 2001 The American Association for Thoracic Surgery

Brief Communications

Low-potassium dextran preservation solution improves lung function after human lung transplantation

From the Toronto Lung Transplant Program, Division of Thoracic Surgery, Departments of Surgery^a and Respirology,^b Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Received for publication March 29, 2000. Accepted for publication June 28, 2000. Address for reprints: S. Keshavjee, MD, Director, Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St, EN 10-224, Toronto, Ontario, Canada M5G 2C4 (E-mail: shaf.keshavjee@uhn.on.ca).

Lung transplantation is an established therapeutic modality for end-stage lung diseases. In the immediate post-transplantation period, life-threatening graft dysfunction occurs in up to 20% of patients, a percentage that has remained largely unchanged for several years. As reported by the International Society for Heart and Lung Transplantation (ISHLT) in 1999, the 5-year survival after lung transplantation is approximately 50%. The most important factor adversely affecting long-term survival after lung transplantation is bronchiolitis obliterans syndrome, which is generally considered to be a complex end result of a chronic rejection process. However, about 15% of patients die within the first 3 months after lung transplantation of severe organ dysfunction related to ischemia/reperfusion injury, acute rejection, and infection. ¹

In clinical practice, acceptable graft storage times are limited to around 6 hours. A recent report reaffirmed the occurrence of diminishing graft function after periods of storage in excess of 4 hours. ² The strategy used for preservation of lung grafts is important and has been the subject of much experimental research over the past 10 years. It has been shown that inflated lungs are able to maintain aerobic metabolism during the period of cold ischemia. ³ In contrast, solid organs such as the liver and pancreas undergo anaerobic metabolism during storage. Despite this, those organs can be stored safely for up to 24 hours with current techniques, reflecting perhaps a better understanding of the behavior of those organs during ischemia and also their inherently more robust anatomic characteristics.

Much experimental work has been directed toward improving the quality of lung preservation, in particular the evaluation of low-potassium dextran solution (LPD), University of . . . [Full Text of this Article]

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