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

• Published in: The Ochsner journal 2019-01, Vol.19 (3), p.235-240
• Main Authors: Boys, Joshua A, Bowdish, Michael E, Subramanyan, Ram Kumar, Shemanski, Kimberly A, Dhillon, Gundeep S, Toda, Koichi, Perrillo, Johanna, Seoane, Leonardo, Bates, Michael J, Parrino, P Eugene, Kooperkamp, Hannah, Valentine, Vincent G, Emory, W Brooks, Ochsner, John L, McFadden, P Michael
• Format: Article
• Language: English
• Subjects: Original Research
• ISSN: 1524-5012; 1524-5012
• DOI: 10.31486/toj.19.0027

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. 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. 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, =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 ( =0.034) compared to the control group. : 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.