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Does Perfadex affect outcomes in clinical lung transplantation?
J Heart Lung Transplant 2005; 24(12):2243-8JH

Abstract

BACKGROUND

The use of a low-potassium-based preservation solution improves gas exchange in experimental models of lung transplantation. However, its efficacy in reducing the incidence of primary graft dysfunction (PGD) and improving patient outcomes in the clinical setting is controversial.

METHODS

In this study we measured: oxygenation index (OI); International Society of Heart and Lung Transplantation (ISHLT) PGD grades; extubation times; intensive care unit (ICU) and hospital length of stay; 30-day, 90-day and 1-year survival rates; and bronchiolitis obliterans syndrome (BOS)-free survival. We compared 115 consecutive (2001 to 2004) lung recipients who received allografts preserved with Perfadex, a low-potassium dextran (LPD) solution, and compared the results with the previous 116 consecutive (1999 to 2001) lung recipients who received allografts preserved with modified Euro-Collins (MEC) solution. Recipients were classified as having severe PGD (ISHLT Grade III) if the lowest arterial oxygenation (P) to fraction of inspired oxygen (F) (P/F ratio) within 48 hours post-transplantation was <200.

RESULTS

Baseline characteristics of the 2 cohorts were similar except for recipient age (LPD 53.5 vs MEC 49.9 years; p = 0.03). There were no differences in donor age, gender, category of transplant, indication for transplant, use of cardiopulmonary bypass or pre-operative pulmonary artery pressures. When gas-exchange parameters were measured upon arrival to the ICU (T0), at 24 hours post-transplant (T24) and at 48 hours post-transplant (T48), the only significant finding was that the incidence of ISHLT Grade III PGD at T24 was lower in the LPD group compared with the MEC group (8% vs 20%, p = 0.03). The incidence of severe PGD at other timepoints was not statistically different (LPD vs MEC: T0, 17% vs 26%; T0 to T48, 25% vs 31%). Both groups had similar extubation rates at 48 hours post-transplant (LPD 64% vs MEC 67%). The 30-day survival (LPD 93% vs MEC 95%), 90-day survival (LPD 89% vs MEC 89%), 1-year patient survival (LPD 80% vs MEC 77%) and 1-year BOS-free survival (LPD 70% vs MEC 74%) were not statistically different.

CONCLUSIONS

Lung preservation with LPD as compared with MEC does not improve early gas exchange or impact 90-day and 1-year mortality. Continued investigation into lung preservation solution composition is necessary to reduce the incidence of PGD.

Authors+Show Affiliations

Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16364877

Citation

Nath, Dilip S., et al. "Does Perfadex Affect Outcomes in Clinical Lung Transplantation?" The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 24, no. 12, 2005, pp. 2243-8.
Nath DS, Walter AR, Johnson AC, et al. Does Perfadex affect outcomes in clinical lung transplantation? J Heart Lung Transplant. 2005;24(12):2243-8.
Nath, D. S., Walter, A. R., Johnson, A. C., Radosevich, D. M., Prekker, M. E., Herrington, C. S., ... Kelly, R. F. (2005). Does Perfadex affect outcomes in clinical lung transplantation? The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 24(12), pp. 2243-8.
Nath DS, et al. Does Perfadex Affect Outcomes in Clinical Lung Transplantation. J Heart Lung Transplant. 2005;24(12):2243-8. PubMed PMID: 16364877.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does Perfadex affect outcomes in clinical lung transplantation? AU - Nath,Dilip S, AU - Walter,Adam R, AU - Johnson,Adam C, AU - Radosevich,David M, AU - Prekker,Mark E, AU - Herrington,Cynthia S, AU - Dahlberg,Peter S, AU - Kelly,Rosemary F, PY - 2005/04/18/received PY - 2005/06/03/revised PY - 2005/06/21/accepted PY - 2005/12/21/pubmed PY - 2006/7/11/medline PY - 2005/12/21/entrez SP - 2243 EP - 8 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 24 IS - 12 N2 - BACKGROUND: The use of a low-potassium-based preservation solution improves gas exchange in experimental models of lung transplantation. However, its efficacy in reducing the incidence of primary graft dysfunction (PGD) and improving patient outcomes in the clinical setting is controversial. METHODS: In this study we measured: oxygenation index (OI); International Society of Heart and Lung Transplantation (ISHLT) PGD grades; extubation times; intensive care unit (ICU) and hospital length of stay; 30-day, 90-day and 1-year survival rates; and bronchiolitis obliterans syndrome (BOS)-free survival. We compared 115 consecutive (2001 to 2004) lung recipients who received allografts preserved with Perfadex, a low-potassium dextran (LPD) solution, and compared the results with the previous 116 consecutive (1999 to 2001) lung recipients who received allografts preserved with modified Euro-Collins (MEC) solution. Recipients were classified as having severe PGD (ISHLT Grade III) if the lowest arterial oxygenation (P) to fraction of inspired oxygen (F) (P/F ratio) within 48 hours post-transplantation was <200. RESULTS: Baseline characteristics of the 2 cohorts were similar except for recipient age (LPD 53.5 vs MEC 49.9 years; p = 0.03). There were no differences in donor age, gender, category of transplant, indication for transplant, use of cardiopulmonary bypass or pre-operative pulmonary artery pressures. When gas-exchange parameters were measured upon arrival to the ICU (T0), at 24 hours post-transplant (T24) and at 48 hours post-transplant (T48), the only significant finding was that the incidence of ISHLT Grade III PGD at T24 was lower in the LPD group compared with the MEC group (8% vs 20%, p = 0.03). The incidence of severe PGD at other timepoints was not statistically different (LPD vs MEC: T0, 17% vs 26%; T0 to T48, 25% vs 31%). Both groups had similar extubation rates at 48 hours post-transplant (LPD 64% vs MEC 67%). The 30-day survival (LPD 93% vs MEC 95%), 90-day survival (LPD 89% vs MEC 89%), 1-year patient survival (LPD 80% vs MEC 77%) and 1-year BOS-free survival (LPD 70% vs MEC 74%) were not statistically different. CONCLUSIONS: Lung preservation with LPD as compared with MEC does not improve early gas exchange or impact 90-day and 1-year mortality. Continued investigation into lung preservation solution composition is necessary to reduce the incidence of PGD. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/16364877/Does_Perfadex_affect_outcomes_in_clinical_lung_transplantation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(05)00434-1 DB - PRIME DP - Unbound Medicine ER -