PULMONARY GRAFT PRESERVATION - A WORLDWIDE SURVEY OF CURRENT CLINICAL-PRACTICE

Background: mush perfusion of pulmonary grafts with cold modified Euro Collins solution supplemented by prostaglandin treatment was introduce d clinically 10 years ago. Primary graft failure remains a major cause of morbidity and death after lung transplantation. During the last de cade, much experimental work has led to reports of alternative storage solutions, differing storage conditions, and pharmacologic interventi ons that improve pulmonary graft performance. It is unclear how these findings have influenced current clinical practice. Methods: A worldwi de survey of the 125 centers performing lung transplantation was condu cted by questionnaire. Results: One hundred twelve replies were receiv ed (90%). Most centers (n = 86) continue to use EuroCollins solution ( 77%), of whom 69% include prostaglandin therapy and 32% donor steroid treatment. University of Wisconsin solution (UW) is used by 15 centers (13.5%), of which 10 (67%) use prostaglandin and seven (47%) use dono r steroids. Nine centers use Papworth solution and one uses donor core cooling. The volume of flush used varied widely, from 20 to 120 ml/kg , with median volumes of 60, 60, and 30 ml/kg in centers using EuroCol lins, UW, and Papworth solutions, respectively Two thirds of centers u sing EuroCollins solution store grafts at 0 degrees to 5 degrees C, an d one third at 5 degrees to 10 degrees C. One center that uses EuroCol lins solution stores grafts at 10 degrees to 15 degrees C. Centers usi ng UW solution are evenly split at 0 degrees to 5 degrees C and 5 degr ees to 10 degrees C. Most centers that use Papworth solution store gra fts at 5 degrees to 10 degrees C. Only six centers use superoxide radi cal scavengers. The maximum ischemic period accepted by centers varies from 4 to 12 hours, with median periods of 8, 7, 6, and 6 hours for t he UW, EuroCollins, Papworth, and donor core cooling centers, respecti vely. All but one of the UW centers (93%) expressed satisfaction with the quality of graft preservation achieved by UW solution. Only 58 of the 86 centers using EuroCollins solution (67%) were satisfied. Six of nine centers using Papworth solution were satisfied. Conclusions: The re has been a trend toward the use of UW solution and a slightly warme r storage temperature. However, for most centers, graft storage techni ques have changed little over the last decade.