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J Thorac Cardiovasc Surg 2006;132:1447-1454
© 2006 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Ultrafiltration attenuates cardiopulmonary bypass–induced acute lung injury in a canine model of single-lung transplantation

^a Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
^b Department of Medical Informatics, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan.

Received for publication April 20, 2006; revisions received July 19, 2006; accepted for publication August 7, 2006.

^_* Address for reprints: Masanori Tsuchida, MD, Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan. (Email: mtsuchi{at}med.niigata-u.ac.jp).

OBJECTIVE: The purpose of this study was to investigate the effects of cardiopulmonary bypass and ultrafiltration on graft function in a canine single-lung transplantation model.

METHODS: Fifteen left single-lung transplantations were done in weight-mismatched canine pairs. The animals were divided into 3 groups: group 1, in which transplantation was done without cardiopulmonary bypass; group 2, in which transplantation was done with cardiopulmonary bypass and in which the cardiopulmonary bypass flow was decreased slowly with controlled pulmonary artery pressure; and group 3, in which transplantation was done with cardiopulmonary bypass and ultrafiltration. Hemodynamic parameters and lung function were monitored for 6 hours after reperfusion. The grafts were harvested for histologic studies, myeloperoxidase assay, and real-time quantitive reverse transcription–polymerase chain reaction of mRNA encoding interleukin 6.

RESULTS: The hemodynamic parameters were similar among the 3 groups. In group 1 PaO ₂ and alveolar to arterial gradient for O₂ levels were excellent throughout the 6-hour observation period, but in group 2 they progressively deteriorated. However, ultrafiltration significantly (P = .02) improved the PaO ₂ level in group 3. On histology, interstitial edema and polynuclear cell infiltration were most marked in group 2 and significantly worse than in groups 1 and 3. Myeloperoxidase assay and real-time quantitative reverse transcription–polymerase chain reaction showed increased myeloperoxidase activity and interleukin 6 gene expression in group 2 grafts compared with group 1 grafts. Myeloperoxidase activity and interleukin 6 gene expression were suppressed with ultrafiltration.

CONCLUSIONS: Cardiopulmonary bypass had negative effects on the graft, but ultrafiltration attenuated acute lung dysfunction by reducing the inflammatory response.