Cardiopulmonary bypass, controlled reperfusion and C-1 esterase inhibitor reduce reperfusion injury in clinical lung transplantation

Objectives: Postoperative graft failure remains the major risk for early mortality after lung transplantation. To reduce reperfusion injury, cardiopulmonary bypass was used allowing for controlled allograft reperfusion. In addition, C-1 esterase inhibitor (C1-INH) was given. Allograft function and recipient survival in bilateral sequential lung transplantation were assessed.

Material and Methods: A retrospective analysis of 20 patients transplanted for end stage chronic obstructive pulmonary disease was undertaken. Modified low potassium dextran was used for lung preservation. Prior to pressure controlled allograft reperfusion 3000 U of C1-INH was applied. Allograft function was assessed using right heart catherization, mean ratio of PaO2 to fraction of inspired oxygen as well as alveolar – arterial oxygen difference (A-aDO2), time of intubation and by a quantitative chest radiographic infiltration score, which was assigned from 0 (no infiltrates) up to 4 (diffuse, severe infiltrates).

Results: 14 donors were ideal, 6 donors were marginal. CPB time was 274 22min., mean ischemic time 235±43min for the right and 302±54min for the left lung. PaO2/FiO2 was 277±113mmHg, A-aDO2 103±6 and infiltration score 1.5±0.6 (mean±std.) 24h after reperfusion. All patients were free of clinically significant reperfusion edema. Ventilation time was 52±47h (mean±std). 30 day mortality was 3.8%, 1 year survival 84.6%.

Conclusions: Combined use of modified LPD preservation and CPB for pressure controlled reperfusion in combination with C1-INH application completely prevented early graft failure due to ischemia/reperfusion injury in clinical double lung transplantation.