Objective : Modified Euro-Collins® [EC] has been the standard preservation solution in most lung transplant centers. Since May 2000, we have changed to Perfadex® [LPD]. The objective of this retrospective study was to compare the outcome between pulmonary grafts preserved with EC versus LPD.
Methods : A total of 100 consecutive transplantations (98 patients) were reviewed. Donor lungs were flushed with EC (n°1-50) or LPD (n°51-100). Thirty four single lung (EC:n=20;LPD:n=14), 52 double lung (EC:n=20;LPD:n=32) and 14 heart-lung transplantations (EC:n=10;LPD:n=4) were performed. The mean ischemic time overall did not differ between LPD versus EC (308±8 min versus 312±12 min, respectively; p=0.95). Graft function was evaluated by analyzing alveolar/arterial oxygen gradient (A-aPO2) up to 48 hours postoperatively, duration of ventilatory support, length of intensive care stay, and freedom from acute rejection as well as survival up to 1 year. Immunosuppressive regimen was comparable between both groups.
Results : One patient in EC died peroperatively from intractable bleeding and was excluded. No significant difference (p=0.59) was found in A-aPO2 in the donors between LPD and EC. A-aPO2 was significantly lower (p<0.001) in LPD compared to EC up to 48 hours posttransplant (Figure). The median duration of ventilatory support was 4 [1-49] days versus 5 [1-59] days (p=0.56) and the median ICU stay was 8 [2-60] days versus 10 [2-68] days (p=0.23) in LPD and EC respectively. Freedom from acute rejection decreased from 85.8% at 30 days, to 57.1% at 6 months, and further to 52.0% at one year in LPD compared to 74.4%, 50% and 41.0% in EC (p=0.2, p=0.66 and p=0.17, respectively). One-year survival was significantly better (p<0.01) in LPD (92.3%) compared to EC (81.3%).
Conclusion : Preservation of the pulmonary graft with Perfadex® resulted in a better graft function and early patient outcome. Data on long-term outcome will need further follow up.