Effect of controlled reperfusion techniques in human lung transplantation

Abstract

Allograft reperfusion injury is a major clinical problem in human lung transplantation leading to short- and long-term morbidity and mortality. Evaluation of pulmonary injury in animal transplant models has suggested that low-pressure reperfusion and use of modified blood reperfusate solutions diminish injury. Little human data are available. Only one uncontrolled trial consisting of 5 patients has been reported. Since 1994, one faculty member in our program has used a reperfusion technique employing low reperfusion pressure and a modified blood reperfusate while others have not. We evaluated our results in this index group by comparison to a case-matched cohort, thus controlling for confounding clinical parameters. Thirty-nine patients were identified in the index group; sixty-five patients were matched as controls. Patients in the control group consisted of: 1)the ‘twin‘ recipient of an index single lung transplant (contralateral lung from the same donor) and 2) where no ‘twin’ existed (in single and double lung transplants), the recipients of transplants performed immediately before and after an index case in patients with the same indication for transplantation. Twenty-five single and 14 double lung recipients formed the index group; thirty-six single and 29 double lung recipients formed the control group. No significant differences were found between groups in A-a gradient or pO2/FiO2 ratio at 1 or 6 hours postoperatively; pulmonary artery pressures at 1, 6, or 24 hours postoperatively; or time to extubation. Index patients demonstrated trends toward shorter ICU stay (p=.09) and length of hospitalization (p=.13). Cold ischemic time were significantly longer (p=.008) for index cases. Index patients showed a strong trend (p=.057) toward greater survival at 1 year (81.6% vs. 68.3%), 3 years (81.6% vs. 60.4%) and 5 years (65.9% vs. 53.7%) posttransplant. Analysis of radiographic data, rejection episodes and BOS scores in the two groups will be discussed. In conclusion, controlled reperfusion in human lung transplantation may impact favorably on outcomes and warrant further study.