Takahiro Oto

Effect of donor preservation solution and survival in lung transplantation

BACKGROUNDnThe aim of this retrospective study was to determine whether the type of preservation solution significantly alters outcomes in lung transplantation, with particular emphasis on primary graft dysfunction and mortality.nnnMETHODSnData on 310 consecutive lung transplant patients, which were prospectively collected, were analyzed. The main outcome variables were all-cause mortality and primary graft dysfunction. Patients were grouped according to donor organ preservation solution, either Euro-Collins, Papworth solution or Perfadex. Multivariate analysis with an additional sensitivity analysis utilizing a propensity score for the use of Papworth solution was performed.nnnRESULTSnPapworth solution was associated with significantly increased mortality compared with the other preservation solutions [odds ratio (OR) = 2.36 (1.21 to 4.58), p = 0.01]. Perfadex was associated with a reduced incidence of primary graft dysfunction at 48 hours (OR = 0.23 [0.08 to 0.68], p = 0.008). Increasing donor age was also associated with increased risk of death (OR = 1.03 [1.01 to 1.04], p = 0.004).nnnCONCLUSIONnPapworth solution for donor lung preservation is associated with an increased mortality in lung transplant recipients.

Aprotinin in lung transplantation is associated with an increased incidence of primary graft dysfunction

OBJECTIVEnAprotinin has been widely used to reduce bleeding and transfusion requirements in cardiac surgery and in lung transplantation. A recent study found a significant reduction in severe (grade III) primary graft dysfunction (PGD) in lung transplantation where aprotinin had been used. However, recently, concerns regarding the safety of aprotinin have been raised, and the future use of aprotinin is uncertain. In our institution, aprotinin has been widely used in cardiac surgery and transplantation. We decided to review our lung transplant caseload to investigate the impact of aprotinin on PGD and mortality and to guide our future clinical use of this antifibrinolytic.nnnMETHODSnA retrospective review of prospectively collected data on 213 consecutive patients who underwent single- or double-lung transplantation was performed. Ninety-nine patients, who received aprotinin, were compared with 114 patients who did not. The main outcome variables analysed were development of primary graft dysfunction, renal impairment and mortality.nnnRESULTSnAprotinin was associated with a significantly increased risk of PGD in the first 48 h postoperatively (p=0.01).nnnCONCLUSIONSnIn conclusion, although the benefits of aprotinin on blood loss are well established, this study does not provide support for the use of aprotinin to reduce PGD in lung transplantation and indicates that aprotinin may in fact have a detrimental effect.