Fortification of preservation solution with nitroprusside does not alter lung allograft survival in clinical human lung transplantation

Academic Article

Abstract

  • © Academic Division of Ochsner Clinic Foundation. Background:Nitric oxide improves gas exchange following primary lung allograft dysfunction.Nitroprusside, a potent nitric oxide donor, has reduced reperfusion injury and improved oxygenation in experimental lung transplantation. Methods:We sought to study the effect on lung allograft outcomes of fortifying the preservation solution with nitroprusside.We conducted a single-center clinical study of 46 consecutive lung recipients between 1998 and 2000: 24 patients received donor organs preserved in modified Euro-Collins solution with prostaglandin E1 (PGE1) (control group), and 22 patients received organs preserved in modified Euro-Collins with PGE1 and nitroprusside (NP group). The primary endpoint was overall survival. Results: Baseline characteristics were similar between the groups except for a significantly longer graft ischemic time in the NP group vs the control group (253.3±52 vs 225.3±41 minutes, respectively, P=0.04).No significant differenceswere found in partial pressure arterial oxygen to fraction inspired oxygen ratio at ≤48 hours, primary graft dysfunction, or bronchiolitis obliterans-free days. Overall survival at 1, 3, and 5 years was 89%, 73%, and 63% in the control group and 76%, 38%, and 23% in the NP group. Log-rank survival analysis showed that the NP group had a significantly increased risk of mortality (P=0.034) compared to the control group. Conclusion: The addition of nitroprusside to the lung transplant perfusate in this clinical trial did not improve survival; however, a large randomized trial would likely reduce confounding ischemia times and increase the power of the study.
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    Author List

  • Boys JA; Bowdish ME; Subramanyan RK; Shemanski KA; Dhillon GS; Toda K; Perrillo J; Seoane L; Bates MJ; Eugene Parrino P
  • Start Page

  • 235
  • End Page

  • 240
  • Volume

  • 19
  • Issue

  • 3