Extended lung preservation with UW solution does not adversely affect graft outcome

Abstract

INTRODUCTION: In orthotopic lung transplantation (OLT) in humans, 6 hours is generally regarded as the extent of total ischemic time. At UW, our practice has been to use organs that have sustained greater than 6 hours of cold ischemic time for transplantation. Standard preservation techniques include 1mg of PGE prior to cross clamp, infusion of 4L UW solution (4C), and retrograde pulmonary vein flushing of 1000cc UW solution per lung. METHODS: From October 1988 to March 1999, 122 consecutive OLT’s were retrospectively analyzed for preservation time (PT, cross clamp to pulmonary re-perfusion) and outcome (time to poor function). Poor function was defined as time to BOS1 (.20% decrease in FEV1 from post-op baseline) or graft loss. Recipients were divided into two groups; Group 1 PT,8hrs (n580), Group 2 PT.8hrs (n542). Groups were further sub divided by donor age; a ,22yrs, b 23-37yrs, c .38yrs. Bilateral OLT recipients PT were time to second lung re-perfusion. Inter group significance (p,0.05) was determined using chi-square and life table analysis. RESULTS: There were no significant differences between the two groups in terms of recipient age, recipient sex, donor age, and donor sex. Group 1 had significantly more COPD patients (p50.011), whereas Group 2 had significantly more bilateral transplant recipients (p50.0018). There were no significant differences between the two groups in terms of outcome (p50.139). When sub groups were examined for outcome vs. donor age, no significant difference was noticed: Group 1a vs 2a (p50.2953), Group 1b vs 2b (p50.6426) and Group 1c vs 2c (p50.3922). CONCLUSIONS: Preservation times in human orthotopic lung transplantation can be extended beyond 8 hours using UW solution without significantly compromising recipient outcomes.