HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Abbas Ardehali Hillel Laks David Ross Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ardehali, A. Articles by Ross, D. Search for Related Content PubMed PubMed Citation Articles by Ardehali, A. Articles by Ross, D. Related Collections Lung - transplantation

J Thorac Cardiovasc Surg 2003;126:1929-1934
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Modified reperfusion and ischemia-reperfusion injury in human lung transplantation

^a Division of Cardiothoracic Surgery, Department of Surgery, University of California at Los Angeles, Los Angeles, Calif, USA
^b Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California at Los Angeles, Los Angeles, Calif, USA.

Received for publication July 15, 2002; revisions received March 11, 2003; accepted for publication March 12, 2003.

^* Address for reprints: Abbas Ardehali, MD, Division of Cardiothoracic Surgery, 62-246 CHS, UCLA Medical Center, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA
aardehali{at}mednet.ucla.edu

OBJECTIVE: Ischemia-reperfusion injury remains a major cause of mortality and morbidity in clinical lung transplantation. Interaction of activated leukocytes with injured graft endothelial cells participates in the development of ischemia-reperfusion injury. We sought to determine if modification of the reperfusate (with depletion of leukocytes and alteration of its composition) would decrease the incidence of ischemia-reperfusion injury in human lung transplantation when compared with whole blood reperfusion in a historical group of patients.

METHODS: Between June 1999 and July 2001, 23 adult patients undergoing lung transplantation consented to modified reperfusion. After implantation, a catheter was inserted into the main or individual pulmonary arteries, and modified reperfusate was administered at a pressure less than 20 mm Hg. The modified reperfusate was depleted of leukocytes, supplemented with nitroglycerin, adjusted for pH and calcium level, and enriched with aspartate, glutamate, and dextrose. After 10 minutes of modified reperfusion, the removal of pulmonary artery clamp or weaning of cardiopulmonary bypass was performed per usual protocol. Age- and diagnosis-matched historical patients served as the control group. Ischemia-reperfusion injury was defined as PaO₂/FIO₂ < 150 with diffuse infiltrate on the radiograph in absence of other causes.

RESULTS: There was no difference in donor age or oxygenation indices, recipient age, the number of patients requiring cardiopulmonary bypass, ischemia time, and recipient oxygenation indices between the modified reperfusate group and the control group. However, none of the patients in the modified reperfusate group developed ischemia-reperfusion injury in contrast to 5 patients in the control group (P < .05). The early survival in the modified reperfusate group was 96% versus 81% in the control group (P = NS).

CONCLUSION: This study suggests that modification of the reperfusate content decreases the incidence of ischemia-reperfusion injury in human lung transplantation when compared with whole blood reperfusion in a historical group of patients. Modified reperfusate may allow acceptance of marginal lungs and expansion of the donor pool.

This article has been cited by other articles:

				G. T. Schnickel, D. J. Ross, R. Beygui, A. Shefizadeh, H. Laks, R. Saggar, J. P. Lynch III, and A. Ardehali Modified reperfusion in clinical lung transplantation: The results of 100 consecutive cases J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 218 - 223. [Abstract] [Full Text] [PDF]

				D. S. Wilkes, T. M. Egan, and H. Y. Reynolds Lung Transplantation: Opportunities for Research and Clinical Advancement Am. J. Respir. Crit. Care Med., October 15, 2005; 172(8): 944 - 955. [Abstract] [Full Text] [PDF]

				G. D. Buckberg Stroke and extra-cardiac perfusion: new vantage points in brain protection Eur. J. Cardiothorac. Surg., December 1, 2004; 26(Suppl_1): S62 - S67. [Abstract] [Full Text] [PDF]