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): Martin Strüber Stefan Fischer Gregor Warnecke Axel Haverich Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Strüber, M. Articles by Hohlfeld, J. M. Search for Related Content PubMed PubMed Citation Articles by Strüber, M. Articles by Hohlfeld, J. M. Related Collections Lung - transplantation Cardiac - physiology Mechanical Circulatory Assistance Molecular biology Transplantation - heart

J Thorac Cardiovasc Surg 2007;133:1620-1625
© 2007 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Effects of exogenous surfactant instillation in clinical lung transplantation: A prospective, randomized trial

^a Hannover Thoracic Transplant Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
^b Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.

Received for publication April 11, 2006; revisions received December 10, 2006; accepted for publication December 14, 2006.

^_* Address for reprints: Martin Strüber, MD, Director, Hannover Thoracic Transplant Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl Neuberg Strasse 1, 30625 Hannover, Germany. (Email: strueber.martin{at}mh-hannover.de).

Objective: Despite the introduction of low potassium–based preservation strategies for clinical lung transplantation, relevant early graft dysfunction occurs in up to 20% of cases after lung transplantation. This was found to be frequently associated with postreperfusion surfactant dysfunction. We performed a randomized, prospective study investigating the effect of exogenous surfactant instillation into human donor lungs on posttransplant surfactant function and on clinical outcome.

Methods: Exogenous surfactant was instilled into 15 donor lungs before retrieval via bronchoscopy. Bronchoalveolar lavage fluids were taken before instillation as well as 24 hours after transplantation. Surfactant function, phospholipids, and protein content in bronchoalveolar lavage fluids were assessed and clinical data prospectively recorded. Pulmonary function testing was performed 4 weeks after lung transplantation. Additionally, the best forced expiratory volume in 1 second was determined within the first year after lung transplantation. The control group consisted of 14 patients receiving donor lungs without surfactant instillation in randomized order. Pulmonary function test results were further compared with those of 154 consecutive recipients of bilateral lung transplants, which were not involved in the study (historical control).

Results: No deaths occurred during the first year after lung transplantation. Surfactant function in donor lungs was within normal ranges before harvest. In the control group, surfactant function was markedly impaired after reperfusion. This was significantly improved by surfactant substitution. Protein content of the bronchoalveolar lavage fluid in the surfactant group was significantly lower, indicating less leakage through the alveolocapillary membrane. Forced expiratory volume in 1 second after 4 weeks was significantly higher in the surfactant group than in either control group (P = .034 and .01, respectively). Interestingly, the best forced expiratory volume in 1 second during the first year after lung transplantation was significantly higher in both control groups compared with forced expiratory volume measured in examinations 4 weeks after lung transplantation (P = .01). The best forced expiratory volumes in 1 second of control patients were comparable with those in surfactant lungs 4 weeks after transplant.

Conclusions: This study indicates a protective effect of exogenous surfactant instillation to donor lungs before retrieval on post–lung transplantation surfactant function and on early clinical outcome. This approach may help to improve the outcome after lung transplantation in the future.

This article has been cited by other articles:

				B. P. van Putte, P. M. Cobelens, N. van der Kaaij, B. Lachmann, A. Kavelaars, C. J. Heijnen, and J. Kesecioglu Exogenous surfactant attenuation of ischemia-reperfusion injury in the lung through alteration of inflammatory and apoptotic factors J. Thorac. Cardiovasc. Surg., April 1, 2009; 137(4): 824 - 828. [Abstract] [Full Text] [PDF]

				C. Muhlfeld, I-M. Schaefer, L. Becker, C. Bussinger, M. Vollroth, A. Bosch, R. Nagib, N. Madershahian, J. Richter, T. Wahlers, et al. Pre-ischaemic exogenous surfactant reduces pulmonary injury in rat ischaemia/reperfusion Eur. Respir. J., March 1, 2009; 33(3): 625 - 633. [Abstract] [Full Text] [PDF]

				A. Amital, D. Shitrit, Y. Raviv, M. Saute, I. Bakal, B. Medalion, and M. R. Kramer Surfactant as salvage therapy in life threatening primary graft dysfunction in lung transplantation Eur. J. Cardiothorac. Surg., February 1, 2009; 35(2): 299 - 303. [Abstract] [Full Text] [PDF]

				N. P. van der Kaaij, J. Kluin, J. J. Haitsma, M. A. den Bakker, B. N. Lambrecht, B. Lachmann, R. W.F. de Bruin, and A. J.J.C. Bogers Surfactant pretreatment decreases long-term damage after ischemia-reperfusion injury of the lung Eur. J. Cardiothorac. Surg., February 1, 2009; 35(2): 304 - 312. [Abstract] [Full Text] [PDF]

				P. A. Corris and J. D. Christie Update in Transplantation 2007 Am. J. Respir. Crit. Care Med., May 15, 2008; 177(10): 1062 - 1067. [Full Text] [PDF]