Retrograde flushing of the pulmonary vein during explantation: lym­pho­cyte composition in the perfusate and impact on outcome after lung transplantation

K. Budding, E.A. van de Graaf, T. Kardol-Hoefnagel, E.-J.D. Oudijk, H.G. Otten

Chair(s): dr. Martin. J. Hoogduijn, wetenschappelijk medewerker, Erasmus MC & prof. dr. Cees. van Kooten, onderzoeker, LUMC

Wednesday 9 march 2016

16:10 - 16:20h at Zaal 5 & 6

Categories: Parallelsessie (basaal)

Parallel session: Parallelsessie IV - Basaal

Lung transplantation (LTx) remains the final treatment option for patients suffering from endstage lung diseases. Lung preservation is essential for transplantation outcome. Studies have shown a beneficial effect of retrograde flushing on early graft dysfunction and bronchial complications, but there is no concordance in literature. Consequently, antegrade lung perfusion is still the standard method of practice in most centers for LTx procedure.

We investigated total PBMC numbers and the cellular composition in the collected perfusate after retrograde flushing. Furthermore, we studied the influence of the combined antegrade and retrograde flushing procedure on LTx outcome. 

Total cell numbers varied between samples (max. 8.0x108,n=47), but showed a significant correlation, p=0.0005, between PBMC numbers in the flush and amount of perfusion fluid analyzed. The percentage of T (p=0.0027) and B cells (p=0.0010) was decreased in the perfusate, whereas the percentage of NK cells was significantly higher compared to the circulation (p=0.0043). Kaplan-Meier analyses showed no differences on the incidence of chronic rejection or survival in the first 4 years post-LTx between pre- and post- retrograde flush patient groups. However, we observed a significant higher number of patients with episodes of acute rejection (p=0.039).

High numbers of NK cells are present in lung tissue which are removed from the graft via retrograde flushing, which has a beneficial effect on outcome after LTx. Although clinical validation of our observations is essential, the addition of retrograde flushing during organ preservations can be valuable for LTx outcome.