Pulmonary graft preservation: a worldwide survey of current clinical practice

Abstract

Background: Flush perfusion of pulmonary grafts with cold modified EuroCollins solution supplemented by prostaglandin treatment was introduced clinically 10 years ago. Primary graft failure remains a major cause of morbidity and death after lung transplantation. During the last decade, much experimental work has led to reports of alternative storage solutions, differing storage conditions, and pharmacologic interventions that improve pulmonary graft performance. It is unclear how these findings have influenced current clinical practice.

Methods: A worldwide survey of the 125 centers performing lung transplantation was conducted by questionnaire.

Results: One hundred twelve replies were received (90%). Most centers (n = 86) continue to use EuroCollins solution (77%), of whom 69% include prostaglandin therapy and 32% donor steroid treatment. University of Wisconsin solution (UW) is used by 15 centers (13.5%), of which 10 (67%) use prostaglandin and seven (47%) use donor steroids. Nine centers use Papworth solution and one uses donor core cooling. The volume of flush used varied widely, from 20 to 120 ml/kg, with median volumes of 60, 60, and 30 ml/kg in centers using EuroCollins, UW, and Papworth solutions, respectively. Two thirds of centers using EuroCollins solution store grafts at 0 degrees to 5 degrees C, and one third at 5 degrees to 10 degrees C. One center that uses EuroCollins solution stores grafts at 10 degrees to 15 degrees C. Centers using UW solution are evenly split at 0 degrees to 5 degrees C and 5 degrees to 10 degrees C. Most centers that use Papworth solution store grafts at 5 degrees to 10 degrees C. Only six centers use superoxide radical scavengers. The maximum ischemic period accepted by centers varies from 4 to 12 hours, with median periods of 8, 7, 6, and 6 hours for the UW, EuroCollins, Papworth, and donor core cooling centers, respectively. All but one of the UW centers (93%) expressed satisfaction with the quality of graft preservation achieved by UW solution. Only 58 of the 86 centers using EuroCollins solution (67%) were satisfied. Six of nine centers using Papworth solution were satisfied.

Conclusions: There has been a trend toward the use of UW solution and a slightly warmer storage temperature. However, for most centers, graft storage techniques have changed little over the last decade.