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

Abstract

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 dataset 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 (30d, 90d, 1 yr), and rejection in the 1st yr, were examined for intervals with adequate follow-up. Cox proportional hazard regression using 11 variables examined all cause 1-yr mortality. Results Of 4455 patients, 4161 (93.4%) received LPD lungs and 294 (6.6%) received UW lungs. 1105 (24.8%) patients died during the study. There was no mortality difference based on flush solution with all patients examined together. However, patients in the upper two LAS quartiles (Q3:37.8-45.4, Q4:>45.4) receiving LPD lungs had greater 1 yr survival (81.5% vs.73.5%, p=0.02). On multivariable analysis, flush with UW solution resulted in an increased risk of 1 yr mortality (Hz ratio 1.77[1.21–2.58], p=0.003) compared to LPD. Preservation solution did not affect rejection rates in the year after LTx. KM modeling demonstrated the impact 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 yr mortality in high risk LTx recipients.

Preliminary study of coconut water for graft tissues preservation in transplantation

“…The antioxidant activity necessary for the preservation solutions 18 decreases by exposing the coconut water to heat. The highest concentration of potassium in the Belzer and modified coconut solutions could be a factor in explaining the worst preservation capacity, because of the ovarian tissue characteristics 19 . However, the mature coconut water, which has high levels of potassium, was as effective as other substances in the preservation of the implants in the study, with a tendency to better histological preservation of the skin and ovaries.…”

Aktuelle Aspekte der Lungentransplantation

“…Nicht nur die Beurteilung der Organqualität, auch die Protektion des Organs ist wesentlich für den postoperativen Verlauf. Die Low-Potassium-Dextran-Perfusionslösung (LPD-Lösung) vermindert das Risiko des primären Graftversagens und ist in Bezug auf die Organprotektion anderen Lösungen überlegen [40][41][42].…”

Update on lung transplantation: programmes, patients and prospects

“…An array of extracellular solutions (Eurocollins, low potassium dextran, University of Wisconsin, Perfedex) has been used with local additives and variations. The exact constituents were often based on a large number of animal experiments but limited human data; however it is a field that continues to generate studies [50]. Other groups have used more ''physiological'' approaches including blood products such as packed red blood cells (Cambridge solution).…”