RT Journal Article
SR Electronic
T1 Fortification of Preservation Solution With Nitroprusside Does Not Alter Lung Allograft Survival in Clinical Human Lung Transplantation
JF Ochsner Journal
JO Ochsner J
FD O. P. Jindal Global University
SP 235
OP 240
DO 10.31486/toj.19.0027
VO 19
IS 3
A1 Joshua A. Boys
A1 Michael E. Bowdish
A1 Ram Kumar Subramanyan
A1 Kimberly A. Shemanski
A1 Gundeep S. Dhillon
A1 Koichi Toda
A1 Johanna Perrillo
A1 Leonardo Seoane
A1 Michael J. Bates
A1 P. Eugene Parrino
A1 Hannah Kooperkamp
A1 Vincent G. Valentine
A1 W. Brooks Emory
A1 John L. Ochsner
A1 P. Michael McFadden
YR 2019
UL http://www.ochsnerjournal.org/content/19/3/235.abstract
AB 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 differences were 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.