The influence of low potassium dextran (Perfadex (R)) on ischemia-reperfusion injury in experimental and clinical lung transplantation

Background: With an incidence of 50% and a mortality rate of 5%, ischemia-r eperfusion injury represents a serious early complication following lung tr ansplantation. As a possible cause, the potassium content of the preservati on solution is discussed. Material and Methode: In a pig-model of left-sided single lung transplantat ion (30 animals; donors n = 12; recipients n = 12, sham-operated animals n = 6) we investigated the influence of flush-perfusion, using Euro-Collins- (EC) or low potassium dextran (LPD)-solution. A group of sham-operated anim als served as control. Metabolic parameters, endothelial integrity and tran splant function during reperfusion were evaluated. In a clinical study, patients following single-(SLTx) or double lung transp lantation (DLTx) were investigated. Donor organs were flushed with EC (n = 48) or LPD (n = 25), insufflated with oxygen (FiO(2) = 1,0) and stored at 4 degrees C. Duration of ischemia, duration of ventilation and stay on inten sive care unit were calculated. Ischemia-reperfusion injury was classified according to clinical parameters. Experimental results: After flush with EC and 18 h ischemia, a reduction of the tissue ATP content (p < 0.01 vs initial value and LPD) was noted. Endo thelial damage was severe (p < 0.05 vs initial value), paO(2) was decreased . Clinical results: A decreased incidence (56% vs EC: 66%, ns.) and severity of IRI (LPD: Grad I: n = 12; II: n = 1; III: n = 1; EC: Grad 1: n = 13; II: n = 8; III: n = 7; IV: n = 3) was observed. Conclusion: In experimental lung preservation, flush perfusion with LPD led to significant improved metabolical, morphological and functional results. Preservation of human lungs with LPD. A reduction of incidence and severit y of IRI was observed.