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

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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.

CTSNet classification

9
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Abbreviations and Acronyms

BA
blood albumin
BOS
bronchiolitis obliterans syndrome
CC
core cooling
CI
confidence interval
dPGD
death caused by primary graft dysfunction
EC
Euro–Collins
IQR
interquartile range
LPD
low potassium dextran
LTx
lung transplantation
PGD
primary graft dysfunction
UKCTA
United Kingdom Cardiothoracic Transplant Audit

Cited by (0)

This study was carried out with the support of funding from the Department of Health, United Kingdom.