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Research ArticleORIGINAL RESEARCH

Fortification of Preservation Solution With Nitroprusside Does Not Alter Lung Allograft Survival in Clinical Human Lung Transplantation

Joshua A. Boys, Michael E. Bowdish, Ram Kumar Subramanyan, Kimberly A. Shemanski, Gundeep S. Dhillon, Koichi Toda, Johanna Perrillo, Leonardo Seoane, Michael J. Bates, P. Eugene Parrino, Hannah Kooperkamp, Vincent G. Valentine, W. Brooks Emory, John L. Ochsner and P. Michael McFadden
Ochsner Journal September 2019, 19 (3) 235-240; DOI: https://doi.org/10.31486/toj.19.0027
Joshua A. Boys
1Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
MD
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Michael E. Bowdish
2Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
3Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA
MD
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Ram Kumar Subramanyan
2Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
MD, PhD
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Kimberly A. Shemanski
2Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
MD
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Gundeep S. Dhillon
4Heart-Lung Transplant Program, Stanford University School of Medicine, Stanford, CA
MD, MPH
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Koichi Toda
5Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
MD
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Johanna Perrillo
6Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
RN
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Leonardo Seoane
7Division of Pulmonary Medicine and Lung Transplantation, Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA
8The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA
MD
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Michael J. Bates
6Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
8The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA
MD
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P. Eugene Parrino
6Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
MD
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Hannah Kooperkamp
6Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
MD
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Vincent G. Valentine
9Division of Pulmonary, Allergy, and Critical Care Medicine, The Kirklin Clinic, University of Alabama School of Medicine, Birmingham, AL
MD
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W. Brooks Emory
10Division of Pulmonary Medicine, Department of Medicine, Ochsner Clinic Foundation, New Orleans LA
MD
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John L. Ochsner
6Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
8The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA
MD
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P. Michael McFadden
2Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
MD
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  • For correspondence: michael.mcfadden@med.usc.edu
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    Figure.

    Survival curves of Kaplan-Meier estimate. Log-rank survival in months: no nitroprusside (No NTP) vs nitroprusside (NTP); P=0.034.

Tables

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    Table 1.

    Baseline Characteristics by Treatment Group

    Control GroupNitroprusside Group
    Variablen=24 n=22P Value
    Sex, male, n (%)13 (54.2)11 (50)1.0
    Mean age, years ± SD42.8 ± 12.340.6 ± 18.60.64
    Bilateral lung transplant, n (%)19 (79.2)13 (59)0.2
    Single lung transplant, n (%)5 (20.8)9 (40.9)0.2
    Cardiopulmonary bypass, n (%)4 (16.7)5 (22.7)0.61
    Mean operative time, minutes ± SD345.3 ± 95374.3 ± 141.80.43
    Mean ischemia time, minutes ± SD225.3 ± 41253.3 ± 520.04
    Inhaled nitric oxide used postoperatively, n (%)1 (4.2)5 (22.7)0.07
    • View popup
    Table 2.

    Indication for Transplantation by Treatment Group

    ControlNitroprusside
    GroupGroup
    Recipient Pathologyn=24n=22
    Cystic fibrosis7 (29.2)8 (36.4)
    Chronic obstructive pulmonary disease2 (8.3)0
    Eisenmenger syndrome01 (4.5)
    Emphysema8 (33.3)5 (22.7)
    Idiopathic pulmonary fibrosis4 (16.7)6 (27.3)
    Bronchiolitis obliterans1 (4.2)2 (9.1)
    Sarcoidosis2 (8.3)0
    • Notes: Data are presented as n (%). P>0.05 for each comparison.

    • View popup
    Table 3.

    Univariable Cox Proportional Hazard Modeling of Risk Factors for Death

    VariableHazard Ratio95% Confidence IntervalP Value
    Recipient age, years0.990.97-1.00.65
    Ischemic time, per 10 minutes1.060.99-1.10.05
    Transfusion, each0.980.92-1.00.53
    Ventilator time, hours1.000.99-1.00.40
    Intensive care unit, days1.000.99-1.10.10
    Length of stay, days1.000.99-1.00.26
    Height, cm1.800.04-810.74
    Weight, kg0.990.97-1.00.87
    Body mass index, kg/m20.980.09-1.10.66
    Recipient sex, male1.400.74-2.70.29
    Donor cytomegalovirus positive1.090.55-2.10.79
    Recipient cytomegalovirus positive1.110.58-2.10.73
    Caucasian0.610.21-1.80.38
    Bilateral lung transplant0.750.37-1.40.42
    Cardiopulmonary bypass2.090.89-4.80.08
    Inhaled nitric oxide5.501.9-150.001
    Chronic obstructive pulmonary disease1.900.42-9.10.39
    Eisenmenger syndrome0.810.10-6.40.84
    Emphysema1.450.62-3.40.38
    Idiopathic pulmonary fibrosis1.100.42-2.80.85
    Bronchiolitis obliterans6.901.7-28.00.006
    Sarcoidosis1.630.2-13.00.64
    Nitroprusside2.001.0-3.80.039
    Donor age, years0.990.97-1.00.64
    Donor sex, male1.410.74-2.60.29
    • View popup
    Table 4.

    Outcomes by Treatment Group

    ControlNitroprusside
    GroupGroup
    Variablen=24n=22P Value
    Transfusion within 24 hours, mean ± SD4.48 ± 0.94.45 ± 6.50.9
    PaO2/FiO2 ratio at <1 hour, mean ± SD283.7 ± 183.4228.6 ± 162.30.29
    PaO2/FiO2 ratio at 12-24 hours, mean ± SD241.8 ± 128.4228.8 ± 115.30.72
    PaO2/FiO2 ratio at ≥24-48 hours, mean ± SD288.1 ± 127260.4 ± 112.30.44
    Mean ventilator time, hours ± SD81 ± 142.155 ± 83.50.45
    Mean length of stay, days ± SD37 ± 83.420.3 ± 15.50.30
    Primary graft dysfunction at <24 hours, n (%)9 (37.5%)11 (50%)0.55
    Primary graft dysfunction at ≥24 hours, n (%)9 (37.5%)7 (31.8%)0.76
    FEV1 percentage at 12 months, mean ± SD75.7 ± 18.871.5 ± 18.50.57
    Bronchiolitis obliterans–free days, mean ± SD1,220 ± 948.8879 ± 741.10.18
    • FEV1, forced expiratory volume in 1 second; PaO2/FiO2, partial pressure arterial oxygen to fraction inspired oxygen ratio.

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Ochsner Journal: 19 (3)
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Fortification of Preservation Solution With Nitroprusside Does Not Alter Lung Allograft Survival in Clinical Human Lung Transplantation
Joshua A. Boys, Michael E. Bowdish, Ram Kumar Subramanyan, Kimberly A. Shemanski, Gundeep S. Dhillon, Koichi Toda, Johanna Perrillo, Leonardo Seoane, Michael J. Bates, P. Eugene Parrino, Hannah Kooperkamp, Vincent G. Valentine, W. Brooks Emory, John L. Ochsner, P. Michael McFadden
Ochsner Journal Sep 2019, 19 (3) 235-240; DOI: 10.31486/toj.19.0027

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Fortification of Preservation Solution With Nitroprusside Does Not Alter Lung Allograft Survival in Clinical Human Lung Transplantation
Joshua A. Boys, Michael E. Bowdish, Ram Kumar Subramanyan, Kimberly A. Shemanski, Gundeep S. Dhillon, Koichi Toda, Johanna Perrillo, Leonardo Seoane, Michael J. Bates, P. Eugene Parrino, Hannah Kooperkamp, Vincent G. Valentine, W. Brooks Emory, John L. Ochsner, P. Michael McFadden
Ochsner Journal Sep 2019, 19 (3) 235-240; DOI: 10.31486/toj.19.0027
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