Organ preservationResolution of Severe Ischemia–Reperfusion Injury Post–Lung Transplantation After Administration of Endobronchial Surfactant
Section snippets
Methods
In 106 consecutive patients, 18 single-lung, 81 bilateral lung and 7 heart–lung transplants were performed between 1996 and 2004. Standard donor criteria were applied as described elsewhere.6 Donor lungs were treated with systemic heparin and the pulmonary bed flushed anterograde with Papworth preservation solution after intravenous administration of 500 μg prostacyclin. A retrograde flush via the pulmonary vein was performed after left atrial anastomosis. Donor lungs were transported in
Results
Six patients, including 5 BSSLTxs and 1 re-do heart–lung transplant, mean age 46 years (range 29 to 62), were diagnosed with severe IRI (Table 1). The mean graft ischemic time was 376 minutes (range 187 to 625); CPB time was 174 minutes (range 0 to 210). Endobronchial surfactant was administered at a mean of 37 hours post-transplant (range 2.3 to 98) and significant resolution of radiologic infiltrates was evident in all cases within 24 hours (Figure 1, Figure 2). The mean Pao2/Fio2 ratio
Discussion
Primary graft dysfunction is the end result of multiple insults occurring from the time of brainstem death through the time of lung reperfusion and post-operative ventilation. It causes significant morbidity and mortality after transplantation.1 IRI has been identified as the main cause of early allograft dysfunction. The clinical syndrome of IRI is characterized by hypoxemia, decreased pulmonary compliance, and progressive alveolar infiltrates on chest radiography within 72 hours of
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Cited by (44)
Surfactant therapy in lung transplantation: A systematic review and meta-analysis
2021, Transplantation ReviewsCitation Excerpt :Of the 6 studies, in 4 studies [26,27,30,31] surfactant was given pre-emptively, while in 2 studies [28,29] it was given as a rescue therapy. One study [31] administered surfactant by means of inhalation, while the remaining administered surfactant intratracheally or endobronchially [26–30]. The majority of administered surfactants were bovine-derived (4 studies) [26,28,29,31], while one was porcine-derived [27], and the remaining was synthetic [30].
Surfactant improves graft function after gastric acid-induced lung damage in lung transplantation
2013, Annals of Thoracic SurgeryProphylaxis with nebulized liposomal amphotericin B for Aspergillus infection in lung transplant patients does not cause changes in the lipid content of pulmonary surfactant
2013, Journal of Heart and Lung TransplantationProtective effect of pre-recovery surfactant inhalation on lungs donated after cardiac death in a canine lung transplantation model
2012, Journal of Heart and Lung TransplantationCitation Excerpt :Thus, massive protein leakage in the NS group could have deteriorated the surfactant function. Surfactants have been administered to patients with severe primary graft dysfunction13,14 and to donor lungs for the prevention of primary graft dysfunction.15 Surfactant administration has been said to be relatively safe and non-invasive, but its use in clinical lung transplantation is still rare owing to the high costs.15