EFFECT OF CARDIOPULMONARY BYPASS ON EARLY GRAFT DYSFUNCTION IN CLINICAL LUNG TRANSPLANTATION

The records of 100 lung transplant recipients (13 heart-lungs, 45 doub le-lungs, and 42 single-lungs) from September 1990 through April 1992 were reviewed to determine the role of cardiopulmonary bypass (CPB) in early graft dysfunction. Fifty-five patients requiring CPB (CPB group ) for 186 +/- 54 minutes were compared with the 45 patients without CP B (no-CPB group). All of the heart-lung and en-bloc double-lung transp lantations were performed under CPB, with pulmonary vascular lung dise ase the principal diagnosis, resulting in a significantly younger age population in the CPB group. All other donor- and recipient-related fa ctors matched well in both groups. Of 38 bilateral single-lung transpl antations, CPB was used in 18. In double-lung and heart-lung recipient s gas exchange of the allografts was evaluated by the arterial/alveola r oxygen tension ratios at nine intervals during the first 72 hours. T he mean arterial/alveolar oxygen tension ratio in the CPB group was 0. 48 +/- 0.19, significantly lower than in the no-CPB group with 0.60 +/ - 0.22 (p = 0.025). All patients had radiographic interpretation and s coring of pulmonary infiltrates from chest roentgenograms taken within 12 hours after reperfusion. The CPB group had more severe pulmonary i nfiltrates than the no-CPB group (p = 0.034). Prolonged intubation def ined as 7 days or longer occurred significantly more often (29/55) in the CPB group than in the no-CPB group (8/45) (p = 0.003). Actuarial g raft and patient survival at 1 month was better in the no-CPB group th an in the CPB group (42/45 versus 44/55 [p = 0.05] and 43/45 versus 45 /55 [p = 0.033], respectively). These results suggest that the interac tion between CPB and preservation injury exaggerates pulmonary dysfunc tion in clinical lung transplantation.