C1-Esterase-Inhibitor Counteracts Severe Primary Graft Dysfunction in Lung Transplantation

Abstract

Purpose Primary Graft Dysfunction(PGD)in Lung Transplantation (LTX) occurs in 8-20% of all LTX and usually is combined with increased morbidity and mortality of 30-40%. A deficit of C1-INH presents a clinical picture of severe capillary leakage. Therefore, we hypothesized that application of C1-INH in LTX recipients that show first signs of severe ischemia-reperfusion injury attenuates PGD. Methods and Materials All LTX recipients that showed low oxygenation indices ( Results A total of 296 LTX were performed between May 2010 and September 2012 at our centre. Out of this, 24 patients (8.11%) developed a low oxygenation index at the end of surgery (mean 85.46 mmHg) and were treated with C1-INH. The PGD Score (ISHLT) was significantly higher in the C1-INH treated group directly postoperatively, 24 hours, 48 hours and 72 hours postoperatively (T0 2.42±0.21vs. 0,74±0.06, p Conclusions PGD is a serious complication after LTX, but treatment with C1-INH led to acceptable morbidity and mortality. Although survival in the C1-INH treated patients was lower than in the remaining collective, it was effectively as good or better as what is internationally regarded as reasonable outcome after LTX in general (>83% one-year-survival).