Retrograde vs. antegrade lung flush perfusion for graft preservation in clinical lung transplantation

Abstract

Objectives: Reports by us and others on experimental studies have indicated a beneficial effect of retrograde lung flush perfusion on posttransplant outcome. We have developed a novel in-situ retrograde lung flush perfusion strategy and compared it with a common antegrade lung flush perfusion technique in clinical lung transplantation (LTx). Methods: 121 LTx procedures in 119 patients were consecutively included into the study from January 2002 to May 2003. All data were prospectively recorded. Antegrade (AP) donor lung perfusion was performed in 84, retrograde (RP) perfusion in 37 cases. Low-potassium dextrane glucose solution (LPDG) was used for lung preservation. Prostacycline (40 yg/l) was added to the flush solution. Main endpoints included ischemic time, PaO2/FiO2 ratio 2,4,8,12, and 24 hrs after arrival on the ICU, time to extubation, and 30-day mortality. Minor endpoints included indication for LTx, gender, age and donor/ recipient gender match. Results: There were no differences in total ischemic time in both groups with 310 98 vs. 305 102 min for right lungs and 373 91 vs. 369 93 min for left lungs in the AP and the RP group, respectively. Lung graft function (PaO2/FiO2 ratio) did not significantly differ among groups at any time point. However, there was a mild trend towards improved function in the RP group at the early time points. Posttransplant ventilation time was significantly lower in the RP group with 113 266 hrs vs. 212 328 hrs in the AP group (p 0.05). The mean length of posttransplant ICU stay was not different among groups (RP: 12.7 17.5 days vs. AP: 11.7 14.4 days). Perioperative mortality was 10 % in the RP group vs. 9% in the AP-cohort. Conclusions: This clinical study does not underline the previously, in experimental studies observed beneficial effect of retrograde lung flush perfusion for lung graft preservation compared to antegrade perfusion. Detailed investigations are warranted to determine these controversial results in human lung transplantation.