Low potassium dextran is superior to University of Wisconsin solution in high-risk lung transplant recipients

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:29

Article

Arnaoutakis, George J.¹  Allen, Jeremiah G.¹  Merlo, Christian A.²  Baumgartner, William A.¹  Conte, John V.¹  Shah, Ashish S.¹ 

[1] Johns Hopkins Univ Hosp, Div Cardiac Surg, Johns Hopkins Med Inst, Baltimore, MD 21287 USA

[2] Johns Hopkins Med Inst, Div Pulmonol, Baltimore, MD 21205 USA

关键词: lung transplantation;    UNOS;    organ preservation storage solution;    lung allocation score;   

DOI  :  10.1016/j.healun.2010.05.031

来源: Elsevier

【 摘 要 】

BACKGROUND The ideal solution for recovery of donor lungs remains unknown Low potassium dextran (LPD) solution is most common, but University of Wisconsin (UW) solution is also used The United Network for Organ Sharing (UNOS) database allows assessment of preservation solutions m a large cohort of lung transplant (LTx) patients METHODS We retrospectively reviewed the UNOS data set for adult primary LTx patients (2005 2008) whose donor lungs were recovered with UW or LPD solution Patients were stratified by UW vs LPD, and secondarily grouped by quartiles of the lung allocation score (LAS) to examine high-risk recipients Kaplan-Meier (KM) short-term mortality (30 days 90 days I year) and rejection in the first year were examined for intervals with adequate follow-up Cox proportional hazard regression using 11 variables examined all cause 1-year mortality RESULTS Of 4,455 patients, 4 161 (93 4%) received LPD lungs and 294 (66%) received UW lungs, and 1,105 patients (24 8%) died during the study There was no mortality difference based on flush solution with all patients examined together However, patients in the upper 2 LAS quartiles (Q3 37 8-454, Q4 > 45 4) receiving LPD lungs had greater 1-year survival of 81 5% vs 73 5% (p = 0 02) On multivariable analysis, flush with UW solution resulted in an increased risk of 1-year mortality (hazard ratio 1 77 95% confidence interval, I 21-2 58, p = 0 003) vs LPD Preservation solution did not affect rejection rates in the year after LTx KM modeling demonstrated the effect of flush solution on survival (p = 0 02) CONCLUSIONS This study is the largest modern cohort to evaluate the effect of donor lung flush solutions on survival in adult LTx UW solution increases the risk of 1-year mortality in high-risk LTx recipients J Heart Lung Transplant 2010 29 1380-7 (C) 2010 International Society for Heart and Lung Transplantation All rights reserved

【 授权许可】

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