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

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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.

Table 1.

Baseline Characteristics by Treatment Group

	Control Group	Nitroprusside Group
Variable	n=24	n=22	P Value
Sex, male, n (%)	13 (54.2)	11 (50)	1.0
Mean age, years ± SD	42.8 ± 12.3	40.6 ± 18.6	0.64
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 ± SD	345.3 ± 95	374.3 ± 141.8	0.43
Mean ischemia time, minutes ± SD	225.3 ± 41	253.3 ± 52	0.04
Inhaled nitric oxide used postoperatively, n (%)	1 (4.2)	5 (22.7)	0.07

Table 2.

Indication for Transplantation by Treatment Group

	Control	Nitroprusside
	Group	Group
Recipient Pathology	n=24	n=22
Cystic fibrosis	7 (29.2)	8 (36.4)
Chronic obstructive pulmonary disease	2 (8.3)	0
Eisenmenger syndrome	0	1 (4.5)
Emphysema	8 (33.3)	5 (22.7)
Idiopathic pulmonary fibrosis	4 (16.7)	6 (27.3)
Bronchiolitis obliterans	1 (4.2)	2 (9.1)
Sarcoidosis	2 (8.3)	0

Table 3.

Univariable Cox Proportional Hazard Modeling of Risk Factors for Death

Variable	Hazard Ratio	95% Confidence Interval	P Value
Recipient age, years	0.99	0.97-1.0	0.65
Ischemic time, per 10 minutes	1.06	0.99-1.1	0.05
Transfusion, each	0.98	0.92-1.0	0.53
Ventilator time, hours	1.00	0.99-1.0	0.40
Intensive care unit, days	1.00	0.99-1.1	0.10
Length of stay, days	1.00	0.99-1.0	0.26
Height, cm	1.80	0.04-81	0.74
Weight, kg	0.99	0.97-1.0	0.87
Body mass index, kg/m²	0.98	0.09-1.1	0.66
Recipient sex, male	1.40	0.74-2.7	0.29
Donor cytomegalovirus positive	1.09	0.55-2.1	0.79
Recipient cytomegalovirus positive	1.11	0.58-2.1	0.73
Caucasian	0.61	0.21-1.8	0.38
Bilateral lung transplant	0.75	0.37-1.4	0.42
Cardiopulmonary bypass	2.09	0.89-4.8	0.08
Inhaled nitric oxide	5.50	1.9-15	0.001
Chronic obstructive pulmonary disease	1.90	0.42-9.1	0.39
Eisenmenger syndrome	0.81	0.10-6.4	0.84
Emphysema	1.45	0.62-3.4	0.38
Idiopathic pulmonary fibrosis	1.10	0.42-2.8	0.85
Bronchiolitis obliterans	6.90	1.7-28.0	0.006
Sarcoidosis	1.63	0.2-13.0	0.64
Nitroprusside	2.00	1.0-3.8	0.039
Donor age, years	0.99	0.97-1.0	0.64
Donor sex, male	1.41	0.74-2.6	0.29

Table 4.

Outcomes by Treatment Group

	Control	Nitroprusside
	Group	Group
Variable	n=24	n=22	P Value
Transfusion within 24 hours, mean ± SD	4.48 ± 0.9	4.45 ± 6.5	0.9
PaO₂/FiO₂ ratio at <1 hour, mean ± SD	283.7 ± 183.4	228.6 ± 162.3	0.29
PaO₂/FiO₂ ratio at 12-24 hours, mean ± SD	241.8 ± 128.4	228.8 ± 115.3	0.72
PaO₂/FiO₂ ratio at ≥24-48 hours, mean ± SD	288.1 ± 127	260.4 ± 112.3	0.44
Mean ventilator time, hours ± SD	81 ± 142.1	55 ± 83.5	0.45
Mean length of stay, days ± SD	37 ± 83.4	20.3 ± 15.5	0.30
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 ± SD	75.7 ± 18.8	71.5 ± 18.5	0.57
Bronchiolitis obliterans–free days, mean ± SD	1,220 ± 948.8	879 ± 741.1	0.18