Am. J. Respir. Crit. Care Med., Volume 164, Number 7, October 2001, 1204-1208

Influence of Preservation Solution on Early Graft Failure in Clinical Lung Transplantation

GABRIEL THABUT, ISABELLE VINATIER, OLIVIER BRUGIÈRE, GUY LESÈCHE, PHILIPPE LOIRAT, ALAIN BISSON, JEAN MARTY, MICHEL FOURNIER, and HERVÉ MAL

Service de Pneumologie et Réanimation Respiratoire, Service de Chirurgie Thoracique et Vasculaire, Service d'Anesthésie et Réanimation, Hôpital Beaujon, Clichy, France; Groupe de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France; and Unité Inserm 408, Faculté de Médecine Xavier Bichat, Paris, France

The aim of this study was to assess the influence of preservation solution type and extra- or intracellular composition on the occurrence of early graft dysfunction after clinical lung transplantation. For 170 patients who underwent a single (n = 124) or bilateral (n = 46) lung transplantation in two centers in Paris between 1988 and 1999, the preservation technique applied to the donor lung was single-flush perfusion of the pulmonary artery with one of several solutions of intracellular (Euro-Collins, n = 61; University of Wisconsin, n = 24) or extracellular composition (Cambridge, n = 64; Celsior, n = 21). The early postoperative outcome of these patients was reviewed. Reimplantation edema occurred in 48% of all patients, and the overall 1-mo survival rate was 84%. No significant difference in the incidence of edema, duration of mechanical ventilation, and 1-mo survival rate was observed between the four groups or between intra- and extracellular groups. After adjustment for graft ischemic time by means of multivariate analysis, the use of extracellular preservation fluid was associated with a lower incidence of reimplantation edema without effect on 1-mo mortality. Graft ischemic time was associated with both edema occurrence and 1-mo survival rate (p = 0.02 and p = 0.01, respectively). We conclude that extracellular-type solutions are associated with better lung preservation than intracellular-type solutions in clinical transplantation.

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