Low potassium dextran is superior to University of Wisconsin solution in high-risk lung transplant recipients

Arnaoutakis, George J.; Allen, Jeremiah G.; Merlo, Christian A.; Baumgartner, William A.; Conte, John V.; Shah, Ashish S.

doi:10.1016/j.healun.2010.05.031

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 29, Issue 12 , Pages 1380-1387, December 2010

Low potassium dextran is superior to University of Wisconsin solution in high-risk lung transplant recipients

George J. Arnaoutakis, MD
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
Jeremiah G. Allen, MD
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
Christian A. Merlo, MD MPH
- Division of Pulmonology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
William A. Baumgartner, MD
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
John V. Conte, MD
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
Ashish S. Shah, MD
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
- Reprint requests: Ashish S. Shah, MD, Assistant Professor of Surgery, Division of Cardiac Surgery, The Johns Hopkins Hospital, Blalock 618, 600 N Wolfe St, Baltimore, MD 21287. Telephone: 410-502-3900. Fax: 410-955-3809

published online 15 July 2010.

Background

The ideal solution for recovery of donor lungs remains unknown. Low potassium dextran (LPD) solution is most common, but University of Wisconsin (UW) solution is also used. The United Network for Organ Sharing (UNOS) database allows assessment of preservation solutions in a large cohort of lung transplant (LTx) patients.

Methods

We retrospectively reviewed the UNOS data set for adult primary LTx patients (2005–2008) whose donor lungs were recovered with UW or LPD solution. Patients were stratified by UW vs LPD, and secondarily grouped by quartiles of the lung allocation score (LAS) to examine high-risk recipients. Kaplan-Meier (KM) short-term mortality (30 days, 90 days, 1 year) and rejection in the first year were examined for intervals with adequate follow-up. Cox proportional hazard regression using 11 variables examined all cause 1-year mortality.

Results

Of 4,455 patients, 4,161 (93.4%) received LPD lungs and 294 (6.6%) received UW lungs, and 1,105 patients (24.8%) died during the study. There was no mortality difference based on flush solution with all patients examined together. However, patients in the upper 2 LAS quartiles (Q3: 37.8–45.4, Q4: > 45.4) receiving LPD lungs had greater 1-year survival of 81.5% vs 73.5% (p = 0.02). On multivariable analysis, flush with UW solution resulted in an increased risk of 1-year mortality (hazard ratio, 1.77. 95% confidence interval, 1.21–2.58; p = 0.003) vs LPD. Preservation solution did not affect rejection rates in the year after LTx. KM modeling demonstrated the effect of flush solution on survival (p = 0.02).

Conclusions

This study is the largest modern cohort to evaluate the effect of donor lung flush solutions on survival in adult LTx. UW solution increases the risk of 1-year mortality in high-risk LTx recipients.

Key Words: lung transplantation, UNOS, organ preservation, storage solution, lung allocation score