The gold standard in lung preservation

Perfadex® is a lightly buffered ‘extracellular’, (low [K+]) colloid-based electrolyte preservation solution for rapid cooling, perfusion and storage of organs in connection with transplantation.

Perfadex® – A solution for optimal preservation of donor lungs

The composition of Perfadex® has been specifically formulated to preserve the function and integrity of organs rich in endothelium, during flushing and cold ischemic storage, prior to transplantation and reperfusion. The colloid component, dextran 40, particularly protects the microvasculature against post-ischemic reperfusion injury, primarily by preventing pathological leukocyte endothelial interaction.12, 13 It also prevents edema formation during preservation.14, 15, 20

Numerous studies have shown that Perfadex® enables safe preservation of lungs up to twelve hours depending upon the state of the organ during retrieval.1 ,2 ,3 ,4 ,5 ,6 ,7 ,8, 9, 10, 11

The colloid component, dextran 40, particularly protects the microvasculature against post-ischemic reperfusion injury, primarily by preventing pathological leukocyte endothelial interaction.12, 13

The endothelium - a vulnerable tissue

The lung is primarily composed of endothelial cells which line the enormous surface area of the capillaries (equivalent to an entire tennis court) and a similar surface area of types I and II epithelial cells which line the alveoli and secrete surfactant respectively. The endothelium is the most vulnerable tissue and plays a critical role for the structure and function of a normal vessel wall. Endothelial cells produce a variety of biologically active substances that control vascular permeability, vessel tone, coagulation, fibrinolysis and inflammatory responses. Some of these substances, such as proteins which seal the junctions between cells (adhesion molecules), are integral parts of the cell structure. Others, such as nitric oxide (NO), prostacycline, chemokines, or factors involved in coagulation and fibrinolysis, are produced and then released by the endothelial cells either luminally or abluminally.<sup>16</sup>

What causes damage to the endothelium?

A number of factors can injure the pulmonary endothelium during the manipulation and temporary storage involved in the retrieval of donor lungs;

  • Traumatic manipulation during harvesting, evaluation and transplantation
  • Excessive pressure
  • Low temperature – particularly below 2 ⁰C
  • Storage solution – e.g. intracellular type (high K+) solutions
  • Prolonged cold ischemia
  • Ischemia-reperfusion – free radical injury

Consequences of an injured endothelium

Injured endothelium can induce platelet and leukocyte adhesion which triggers a number of inflammatory cascades. These process induces further endothelial damage resulting in ischemic reperfusion injury IRI. A well preserved endothelium is antithrombogenic, yet promotes platelet aggregation and coagulation if injured.17,18

The importance of an intact endothelium

Experimental and clinical evidence indicates that early ischemia-reperfusion injury to the endothelium, within the very first few hours of reperfusion, is a key trigger in initiating immune reactions that might subsequently result in graft failure often months or years later.18 This early injury can be prevented or mitigated by minimizing physical injury (manipulation) and storing the lungs in a protective solution under optimal temperature conditions.19

Current best practice

According to Munshi et al, 2013 21

Current best practice based on the latest research on potential lung donor and lung-preservation techniques advises the use of an extracellular, dextran-based solution.

Lung preservation techniques

  • Extracellular solution consisting of dextran 40, glucose and low potassium
  • Anterograde and retrograde flushing of 60 mL/kg and max 30 cm height
  • Storage temperature 2-8 ⁰C
  • Inflation to 50% of total lung capacity, fraction of inspired oxygen 50%
  • Pharmacological additives: prostaglandin E1, heparin, glucocorticoids
  • Cold ischemic times generally less than 8 h
  • Normothermic ex vivo lung perfusion based on lung assessment and therapeutics.

Table modified from “Donor management and lung preservation for lung transplantation”.21


Adjust to about pH 7.4 shortly before use by addition of 1mmol THAM/TRIS (trometamol or tromethamine) per liter Perfadex®. Once additives have been administered or the container has been opened the solution should be kept chilled and used within 24 hours.

Perfadex® is supplied in 1000ml, 2800ml and 3000ml bags. 2800ml bag will be replaced by 3000ml bag, please contact XVIVO Perfusion for availability on your market.

To order:
REF 19001; 8 x 1000 ml, REF 19002; 2 x 2800 ml, REF 19100; 10 x 1000 ml, REF 19300; 2 x 3000 ml

Content and packaging:
19001: 8 x 1000 ml PVC bags with Perfadex®
19002: 2 x 2800 ml PVC bags with Perfadex®
19100: 10 x 1000 ml bags with Perfadex®
19300: 2 x 3000 ml bags with Perfadex®

Storage: Store at room temperature. Do not freeze. Ensure that the bag is not in direct contact with ice. Use only unopened and undamaged packages.
Intended Use: Perfadex® solution for lung perfusion is indicated for the flushing, storage and transportation of isolated lungs after removal from the donor in preparation for eventual transplantation into a recipient.
Properties: Sterility Assurance SAL 10 -6


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  2. Fischer S, et al, J Thorac. Cardiovasc Surg. 2001. 121(3):594-6
  3. Struber M, et al, Eur. J. Cardiothorac. Surg. 2001. 19 (2):190-4.
  4. Rabanal J M, et al, Transplant Proc. 2003. ;35(5):1938-9
  5. Sakamaki F, et al, Am J Respir Crit Care Med. 1997:156:1073-81
  6. Struber M, et al, J Heart Lung Transplant. 1999:18:1:87
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  12. Menger M D. Transplant Proceed. 1995, 27; 5: 2863-65
  13. Hoffman h et al. Z. Hertz-, Thorax-, Gefässchir. 1997, 11: 108-14
  14. Frost -Arner L et al. Microsurgery. 1995, 16: 357-361
  15. Keshavjee SH et al. J Thorac Cardiovascular Surg. 1992; 103:314-25
  16. Toborek M, JKaisers S. Basic Res Cardiol 1999; 94: 295-314
  17. Zilla P et al. J Card Surg 1993; 8: 32-60
  18. Davis S.F. et al. Circulation. 1996; 93: 457-462
  19. Steen S. Scand Cardiovasc J. 2001; 35: 297-301
  20. Arfors K-E,  Buckley, PB, Bailliere´s Clinical Anaesthesiol. 1997;11,1,15-47
  21. Munshi L et al. Lancet Rspeir Med 2013; 1;318-28