Original clinical science
Effect of donor preservation solution and survival in lung transplantation

https://doi.org/10.1016/j.healun.2010.10.002Get rights and content

Background

The 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.

Methods

Data 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.

Results

Papworth 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).

Conclusion

Papworth solution for donor lung preservation is associated with an increased mortality in lung transplant recipients.

Section snippets

Methods

A retrospective review was conducted of prospectively collected data on 310 patients who underwent single- or double-lung transplantation at our institution between January 2000 and December 2007. Data on donor and recipient demographic variables, donor preservation strategy and outcomes were collected. The main outcomes analyzed were all-cause mortality, and PGD at 0, 12, 24 and 48 hours. Donor and recipient demographics are presented in Table 1.

The strategies of recipient selection, donor

Results

Three hundred ten lung transplants (216 double-lung transplants and 94 single-lung transplants) were performed over the 8-year period. Data on preservation solution used in 3 transplants were missing and these patients were excluded from analysis. Heart–lung transplants were also excluded from consideration in this study. The groups had notable differences in some of the variables. The Perfadex and Euro-Collins groups are not historically comparable and this is reflected in the more recent

Discussion

The present results show that the use of Papworth solution for donor lung preservation is associated with significantly increased mortality and an increased risk of severe PGD compared with both Euro-Collins and Perfadex preservation solutions. To our knowledge, there have been no published findings describing the association between Papworth solution and poorer survival in humans after lung transplantation.

Concerns with Papworth solution include the fact that it is made up at the bedside,

Disclosure statement

The authors thank Anne Griffiths and Bronwyn Levvey for their assistance with data collection.

The authors have no conflicts of interest to disclose.

References (13)

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