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J Thorac Cardiovasc Surg 2001;121:1069-1075
© 2001 The American Association for Thoracic Surgery
General Thoracic Surgery |
From the Department of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, Va.
Supported by the National Institutes of Health under R01 grant HL56093-03, National Research Service Award F32 grant HL10248-01, and cooperative agreement U54 HD28934 as part of the Specialized Cooperative Centers Program in Reproduction Research.
Presented at the American College of Surgeons Meeting Surgical Forum, October 22-27, 2000, Chicago, Ill.
Received for publication Sept 13, 2000. Revisions requested Dec 6, 2000; revisions received Dec 12, 2000. Accepted for publication Dec 13, 2000. Address for reprints: Steven M. Fiser, MD, Department of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, PO Box 801359, MR4 Building, Room 3111, Charlottesville, VA 22908 (E-mail: smf9e @virginia.edu).
Objective: Both donor pulmonary macrophages and recipient circulating leukocytes may be involved in reperfusion injury after lung transplantation. By using the macrophage inhibitor gadolinium chloride and leukocyte filters, we attempted to identify the roles of these two populations of cells in lung transplant reperfusion injury.
Methods: With our isolated, ventilated, blood-perfused rabbit lung model, all groups underwent lung harvest followed by 18-hour cold storage and 2-hour blood reperfusion. Measurements of pulmonary artery pressure, lung compliance, and arterial oxygenation were obtained. Group I (n = 8) served as a control. Group II (n = 8) received gadolinium chloride at 14 mg/kg 24 hours before lung harvest. Group III (n = 8) received leukocyte-depleted blood reperfusion by means of a leukocyte filter.
Results: The gadolinium chloride group had significantly improved arterial oxygenation and pulmonary artery pressure measurements compared with control subjects and an improved arterial oxygenation compared with the filter group after 30 minutes of reperfusion. After 120 minutes of reperfusion, however, the filter group had significantly improved arterial oxygenation and pulmonary artery pressure measurements compared with the control group and an improved arterial oxygenation compared with the gadolinium chloride group.
Conclusions: Lung transplant reperfusion injury occurs in two phases. The early phase is mediated by donor pulmonary macrophages and is followed by a late injury induced by recipient circulating leukocytes.
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