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Jagan N. Rao
John H. Dark
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Right arrow Lung - transplantation

J Thorac Cardiovasc Surg 2003;126:2052-2057
© 2003 The American Association for Thoracic Surgery

Cardiothoracic transplantation

Pentoxifylline is as effective as leukocyte depletion for modulating pulmonary reperfusion injury

Stephen C. Clark, FRCS(C/Th)a,*, Jagan N. Rao, FRCSa, Paul A. Flecknell, MRCVSb, John H. Dark, FRCSa

a Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom
b Comparative Biology Centre, The University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom

Received for publication August 7, 2002; revisions received February 26, 2003; accepted for publication April 29, 2003.

* Address for reprints: Stephen C. Clark, the Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
Stephen.Clark{at}nuth.northy.nhs.uk

OBJECTIVE: Previous studies have suggested the amelioration of lung reperfusion injury when initial reperfusion is undertaken with leukocyte-depleted blood. Pharmacologic agents, such as pentoxifylline, are also effective, but no previous studies have demonstrated which is superior. We investigated these agents in a porcine model of left single-lung transplantation.

METHODS: Donor lungs were preserved with modified Euro-Collins solution for a mean ischemic time of 18.6 hours. Gas exchange, pulmonary vascular resistance, neutrophil elastase level, and free radical release (measured on the basis of malonaldehyde levels) were assessed over a 12-hour period. Group A (n = 5) was a control group with no interventions added. Group B was reperfused through an extracorporeal circuit incorporating a leukocyte-depleting filter for 30 minutes before conventional blood flow was restored. Group C was reperfused with the addition of intravenous pentoxifylline (2 mg · kg-1 · h-1).

RESULTS: Groups B and C were similar in terms of oxygenation, pulmonary vascular resistance, and free radical release. Group B displayed increased levels of neutrophil elastase. Both groups were superior with regard to these outcome measures compared with control group A.

CONCLUSIONS: Pentoxifylline, when administered to recipient animals, attenuates reperfusion injury to a degree similar to that seen with leukocyte-depleted reperfusion. This technique is simple, safe, and as effective as using a more complex extracorporeal circuit incorporating a leukocyte-depleting filter to ameliorate acute lung injury.






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