Original Article
Improvements in Lung Preservation: 3 Years' Experience With a Low-Potassium Dextran Solution
P. Gámeza,
, M. Córdobaa, I. Millánb, L. Madrigala, F. Alfagemea, R. Álvareza, I. Núñeza, A. Varelaa
Corresponding author
pgamez.hpth@salud.madrid.org
Correspondence: Dr. P. Gámez García. Servicio de Cirugía Torácica y Cardiovascular. Hospital Universitario Puerta de Hierro. San Martín de Porres, 4. 28035 Madrid. España
Correspondence: Dr. P. Gámez García. Servicio de Cirugía Torácica y Cardiovascular. Hospital Universitario Puerta de Hierro. San Martín de Porres, 4. 28035 Madrid. España
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Armengot Carceller, C. Carda Batalla, A. Escribano, G.J. Samper" "autores" => array:4 [ 0 => array:3 [ "preGrado" => "Dr." "nombre" => "M." "apellidos" => "Armengot Carceller" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Carda Batalla" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Escribano" ] 3 => array:2 [ "nombre" => "G.J." 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"apellidos" => "Gámez" "email" => array:1 [ 0 => "pgamez.hpth@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Córdoba" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Millán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Madrigal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "F." 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"apellidos" => "Varela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Torácica y Cardiovascular, Hospital Universitario Puerta de Hierro, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Estadística, Hospital Universitario Puerta de Hierro, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. P. Gámez García. Servicio de Cirugía Torácica y Cardiovascular. Hospital Universitario Puerta de Hierro. San Martín de Porres, 4. 28035 Madrid. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2003-12-24" "fechaAceptado" => "2004-06-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key Words" "identificador" => "xpalclavsec153653" "palabras" => array:3 [ 0 => "Lung transplantation" 1 => "Ischemia-reperfusion injury" 2 => "Mortality" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec153654" "palabras" => array:3 [ 0 => "Trasplante pulmonar" 1 => "Lesión de isquemia-reperfusión" 2 => "Mortalidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Lung preservation quality is a crucial factor in the success of a lung transplant. In October 2000 we stopped using Euro-Collins (EC) lung preservation solution and began using a low potassium dextran solution (Perfadex [PER]). The objective of the present study was to assess outcome with the 2 solutions.</p> <span class="elsevierStyleSectionTitle">Material and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">We analyzed the results of 68 lung transplants in which PER was used and compared the results with those of a historical control group consisting of the same number of transplants in which EC was used.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">There were no significant differences in the ages and diagnoses of the recipients in the 2 groups. Waiting list time was longer in the PER group. The most frequent cause of donor death in the EC group was craniocerebral trauma (62%), whereas in the PER group it was cerebral hemorrhage (54%). In the PER group more double lung transplants were performed than in the EC group (78% and 53% respectively; <span class="elsevierStyleItalic">P</span> = .002). There were no differences in the use of extracorporal circulation or ischemia time between the 2 groups. Early graft function, based on the patient's oxygenation index (ratio of PaO<span class="elsevierStyleInf">2</span> to inspired oxygen fraction [FiO<span class="elsevierStyleInf">2</span>]) on arrival at the intensive care unit, was similar in the 2 groups. The incidence of severe graft failure (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span><150 mm Hg) was significantly lower in the PER group than in the EC group (16% and 37% respectively; <span class="elsevierStyleItalic">P</span> = .01). No significant differences in hours of mechanical ventilation or postoperative mortality between the 2 patient series were found.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Use of the newer lung preservation solution —PER— led to a 50% lower incidence of severe ischemia -reperfusion graft injury during the early recovery from lung transplantation.</p><p class="elsevierStyleSimplePara elsevierViewall">Mejoras en la preservación pulmonar. Tres años de experiencia con una solución de dextrano bajo en potasio</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La calidad de la preservación pulmonar es uno de los aspectos más determinantes en el éxito del trasplante pulmonar. En octubre del año 2000 modificamos nuestra so-lución de preservación pulmonar, que hasta entonces era el Euro-Collins (EC), y comenzamos a utilizar una solución de dextrano bajo en potasio, comercializada como Perfadex (PER). El objetivo de este estudio es analizar los resultados de ambos métodos.</p> <span class="elsevierStyleSectionTitle">Material y Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Hemos analizado los resultados de 68 trasplantes pulmonares con PER y los hemos comparado con los de una serie retrospectiva del mismo número de trasplantes realizados con EC.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">NO existen diferencias significativas respecto a la edad o el diagnóstico de los receptores entre ambos grupos. El tiempo en lista de espera fue mayor en el grupo de PER. La causa de muerte del donante más frecuente del grupo EC fue el traumatismo craneoencefálico (62%), mientras que en el grupo de PER fue la hemorragia cerebral (54%). En el grupo de PER se realizaron más trasplantes bi-pulmonares que en el de EC (el 78 y el 53 %, respectivamente; p = 0,002). No hay diferencias en la indicación de circulación extracorpórea o tiempos de isquemia entre ambos grupos. Se evaluó la función pulmonar temprana a través del índice de oxigenación (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span>) a la llegada a la uni-dad de cuidados intensivos, que fue comparable entre ambos grupos. La incidencia de disfunción grave del injerto (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> < 150 mmHg) fue significativamente inferior en el grupo de PER frente al de EC (el 16 y el 37%, respectivamente; p = 0,01). No encontramos diferencias significativas respecto a las horas de ventilación mecánica ni en cuanto a la mortalidad postoperatoria entre las 2 series.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Con la aplicación clínica de esta nueva solución de preservación pulmonar se obtiene una reducción del 50% en la incidencia de la lesión de isquemia-reperfusión grave del injerto en el postoperatorio inmediato del trasplante pulmonar.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single flush perfusion with modified Euro-Collins solution: experience in clinical lung preservation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "IW Colquhoun" 1 => "AJB Kirk" 2 => "J Au" 3 => "ID Conacher" 4 => "PA Corris" 5 => "CJ Hilton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "1992" "volumen" => "11" "paginaInicial" => "S209" "paginaFinal" => "SS14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1381219" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Registry of the International Society for Heart and Lung Transplantation: sixteenth official report-1999" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "JD Hosenpud" 1 => "LE Bennett" 2 => "BM Keck" 3 => "B Fiol" 4 => "MM Boucek" 5 => "RJ Novick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "1999" "volumen" => "18" "paginaInicial" => "611" "paginaFinal" => "626" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10452337" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contralateral lung injury associated with single-lung ischemia-reperfusion injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A Watanabe" 1 => "N Kawaharada" 2 => "K Kusajima" 3 => "S Komatsu" 4 => "H Takahashi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg." 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| 2022 August | 17 | 39 | 56 |
| 2022 July | 17 | 37 | 54 |
| 2022 June | 16 | 28 | 44 |
| 2022 May | 11 | 25 | 36 |
| 2022 April | 18 | 28 | 46 |
| 2022 March | 10 | 43 | 53 |
| 2022 February | 14 | 22 | 36 |
| 2022 January | 13 | 28 | 41 |
| 2021 December | 8 | 35 | 43 |
| 2021 November | 11 | 30 | 41 |
| 2021 October | 12 | 45 | 57 |
| 2021 September | 10 | 36 | 46 |
| 2021 August | 8 | 27 | 35 |
| 2021 July | 15 | 32 | 47 |
| 2021 June | 13 | 29 | 42 |
| 2021 May | 12 | 24 | 36 |
| 2021 April | 22 | 46 | 68 |
| 2021 March | 12 | 16 | 28 |
| 2021 February | 11 | 16 | 27 |
| 2021 January | 12 | 10 | 22 |
| 2020 December | 9 | 15 | 24 |
| 2020 November | 10 | 10 | 20 |
| 2020 October | 8 | 7 | 15 |
| 2020 September | 4 | 3 | 7 |
| 2020 August | 6 | 10 | 16 |
| 2020 July | 10 | 12 | 22 |
| 2020 June | 4 | 7 | 11 |
| 2020 May | 10 | 14 | 24 |
| 2020 April | 16 | 9 | 25 |
| 2020 March | 6 | 10 | 16 |
| 2020 February | 19 | 17 | 36 |
| 2020 January | 16 | 17 | 33 |
| 2019 December | 14 | 15 | 29 |
| 2019 November | 8 | 15 | 23 |
| 2019 October | 3 | 6 | 9 |
| 2019 September | 4 | 12 | 16 |
| 2019 August | 11 | 8 | 19 |
| 2019 July | 9 | 23 | 32 |
| 2019 June | 2 | 10 | 12 |
| 2019 May | 13 | 14 | 27 |
| 2019 April | 40 | 28 | 68 |
| 2019 March | 12 | 22 | 34 |
| 2019 February | 10 | 15 | 25 |
| 2019 January | 9 | 13 | 22 |
| 2018 December | 10 | 13 | 23 |
| 2018 November | 11 | 6 | 17 |
| 2018 October | 16 | 12 | 28 |
| 2018 September | 12 | 8 | 20 |
| 2018 May | 5 | 1 | 6 |
| 2018 April | 4 | 5 | 9 |
| 2018 March | 3 | 4 | 7 |
| 2018 February | 4 | 9 | 13 |
| 2018 January | 3 | 6 | 9 |
| 2017 December | 5 | 8 | 13 |
| 2017 November | 3 | 6 | 9 |
| 2017 October | 4 | 8 | 12 |
| 2017 September | 4 | 12 | 16 |
| 2017 August | 8 | 6 | 14 |
| 2017 July | 4 | 5 | 9 |
| 2017 June | 19 | 12 | 31 |
| 2017 May | 5 | 5 | 10 |
| 2017 April | 7 | 7 | 14 |
| 2017 March | 4 | 1 | 5 |
| 2017 February | 3 | 3 | 6 |
| 2017 January | 3 | 4 | 7 |
| 2016 December | 12 | 7 | 19 |
| 2016 November | 12 | 8 | 20 |
| 2016 October | 16 | 6 | 22 |
| 2016 September | 12 | 5 | 17 |
| 2016 August | 14 | 4 | 18 |
| 2016 July | 5 | 2 | 7 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 26 | 1 | 27 |
| 2015 September | 31 | 13 | 44 |
| 2015 August | 16 | 11 | 27 |
| 2015 July | 19 | 7 | 26 |
| 2015 June | 22 | 9 | 31 |
| 2015 May | 36 | 13 | 49 |
| 2015 April | 21 | 11 | 32 |
| 2015 March | 17 | 23 | 40 |
| 2015 February | 13 | 10 | 23 |
| 2015 January | 17 | 6 | 23 |
| 2014 December | 16 | 10 | 26 |
| 2014 November | 17 | 3 | 20 |
| 2014 October | 26 | 10 | 36 |
| 2014 September | 24 | 4 | 28 |
| 2014 August | 27 | 5 | 32 |
| 2014 July | 25 | 6 | 31 |
| 2014 June | 27 | 8 | 35 |
| 2014 May | 30 | 7 | 37 |
| 2014 April | 35 | 8 | 43 |
| 2014 March | 34 | 8 | 42 |
| 2014 February | 33 | 7 | 40 |
| 2014 January | 29 | 8 | 37 |
| 2013 December | 24 | 8 | 32 |
| 2013 November | 23 | 5 | 28 |
| 2013 October | 20 | 6 | 26 |
| 2013 September | 28 | 11 | 39 |
| 2013 August | 25 | 10 | 35 |
| 2013 July | 35 | 10 | 45 |
| 2013 June | 16 | 5 | 21 |
| 2013 May | 30 | 5 | 35 |
| 2013 April | 12 | 8 | 20 |
| 2013 March | 6 | 1 | 7 |
Show all
