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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Lung preservation quality is a crucial factor in the success of a lung transplant&#46; In October 2000 we stopped using Euro-Collins &#40;EC&#41; lung preservation solution and began using a low potassium dextran solution &#40;Perfadex &#91;PER&#93;&#41;&#46; The objective of the present study was to assess outcome with the 2 solutions&#46;</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&#46;</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&#46; Waiting list time was longer in the PER group&#46; The most frequent cause of donor death in the EC group was craniocerebral trauma &#40;62&#37;&#41;&#44; whereas in the PER group it was cerebral hemorrhage &#40;54&#37;&#41;&#46; In the PER group more double lung transplants were performed than in the EC group &#40;78&#37; and 53&#37; respectively&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;002&#41;&#46; There were no differences in the use of extracorporal circulation or ischemia time between the 2 groups&#46; Early graft function&#44; based on the patient&#39;s oxygenation index &#40;ratio of PaO<span class="elsevierStyleInf">2</span> to inspired oxygen fraction &#91;FiO<span class="elsevierStyleInf">2</span>&#93;&#41; on arrival at the intensive care unit&#44; was similar in the 2 groups&#46; The incidence of severe graft failure &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#60;150 mm Hg&#41; was significantly lower in the PER group than in the EC group &#40;16&#37; and 37&#37; respectively&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;01&#41;&#46; No significant differences in hours of mechanical ventilation or postoperative mortality between the 2 patient series were found&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Use of the newer lung preservation solution &#8212;PER&#8212; led to a 50&#37; lower incidence of severe ischemia -reperfusion graft injury during the early recovery from lung transplantation&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">Mejoras en la preservaci&#243;n pulmonar&#46; Tres a&#241;os de experiencia con una soluci&#243;n de dextrano bajo en potasio</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La calidad de la preservaci&#243;n pulmonar es uno de los aspectos m&#225;s determinantes en el &#233;xito del trasplante pulmonar&#46; En octubre del a&#241;o 2000 modificamos nuestra so-luci&#243;n de preservaci&#243;n pulmonar&#44; que hasta entonces era el Euro-Collins &#40;EC&#41;&#44; y comenzamos a utilizar una soluci&#243;n de dextrano bajo en potasio&#44; comercializada como Perfadex &#40;PER&#41;&#46; El objetivo de este estudio es analizar los resultados de ambos m&#233;todos&#46;</p> <span class="elsevierStyleSectionTitle">Material y M&#233;todos</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 n&#250;mero de trasplantes realizados con EC&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">NO existen diferencias significativas respecto a la edad o el diagn&#243;stico de los receptores entre ambos grupos&#46; El tiempo en lista de espera fue mayor en el grupo de PER&#46; La causa de muerte del donante m&#225;s frecuente del grupo EC fue el traumatismo craneoencef&#225;lico &#40;62&#37;&#41;&#44; mientras que en el grupo de PER fue la hemorragia cerebral &#40;54&#37;&#41;&#46; En el grupo de PER se realizaron m&#225;s trasplantes bi-pulmonares que en el de EC &#40;el 78 y el 53 &#37;&#44; respectivamente&#59; p &#61; 0&#44;002&#41;&#46; No hay diferencias en la indicaci&#243;n de circulaci&#243;n extracorp&#243;rea o tiempos de isquemia entre ambos grupos&#46; Se evalu&#243; la funci&#243;n pulmonar temprana a trav&#233;s del &#237;ndice de oxigenaci&#243;n &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41; a la llegada a la uni-dad de cuidados intensivos&#44; que fue comparable entre ambos grupos&#46; La incidencia de disfunci&#243;n grave del injerto &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#60; 150 mmHg&#41; fue significativamente inferior en el grupo de PER frente al de EC &#40;el 16 y el 37&#37;&#44; respectivamente&#59; p &#61; 0&#44;01&#41;&#46; No encontramos diferencias significativas respecto a las horas de ventilaci&#243;n mec&#225;nica ni en cuanto a la mortalidad postoperatoria entre las 2 series&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Con la aplicaci&#243;n cl&#237;nica de esta nueva soluci&#243;n de preservaci&#243;n pulmonar se obtiene una reducci&#243;n del 50&#37; en la incidencia de la lesi&#243;n de isquemia-reperfusi&#243;n grave del injerto en el postoperatorio inmediato del trasplante pulmonar&#46;</p>"
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Vol. 41. Issue 1.
Pages 16-19 (January 2005)
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Vol. 41. Issue 1.
Pages 16-19 (January 2005)
Original Article
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Improvements in Lung Preservation: 3 Years' Experience With a Low-Potassium Dextran Solution
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P. Gámeza,
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
, M. Córdobaa, I. Millánb, L. Madrigala, F. Alfagemea, R. Álvareza, I. Núñeza, A. Varelaa
a Servicio de Cirugía Torácica y Cardiovascular, Hospital Universitario Puerta de Hierro, Madrid, Spain
b Servicio de Estadística, Hospital Universitario Puerta de Hierro, Madrid, Spain
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Objective

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.

Material and Methods

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.

Results

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; P = .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 PaO2 to inspired oxygen fraction [FiO2]) on arrival at the intensive care unit, was similar in the 2 groups. The incidence of severe graft failure (PaO2/FiO2<150 mm Hg) was significantly lower in the PER group than in the EC group (16% and 37% respectively; P = .01). No significant differences in hours of mechanical ventilation or postoperative mortality between the 2 patient series were found.

Conclusions

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.

Mejoras en la preservación pulmonar. Tres años de experiencia con una solución de dextrano bajo en potasio

Key Words:
Lung transplantation
Ischemia-reperfusion injury
Mortality
Objetivo

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.

Material y Métodos

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.

Resultados

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 (PaO2/FiO2) a la llegada a la uni-dad de cuidados intensivos, que fue comparable entre ambos grupos. La incidencia de disfunción grave del injerto (PaO2/FiO2 < 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.

Conclusiones

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.

Palabras clave:
Trasplante pulmonar
Lesión de isquemia-reperfusión
Mortalidad
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Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
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