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J Thorac Cardiovasc Surg 2008;135:679-684
© 2008 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Platelet activation in the postoperative period after lung transplantation

^a Lung Transplant Program, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
^b Lung Transplant Program, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
^c Department of Internal Medicine, University of Michigan, Ann Arbor, Mich

Received for publication June 12, 2007; revisions received August 21, 2007; accepted for publication September 24, 2007.

^_* Address for reprints: Joshua Sonett, MD, Lung Transplant Program, Columbia University College of Physicians & Surgeons, 622 W 168th St, PH-14 Room 104, New York, NY 10032. (Email: js2106{at}columbia.edu).

Objective: During lung transplantation, cells in the pulmonary parenchyma are subjected to ischemia, hypothermic storage, and reperfusion injury. Platelets, whose granular contents include adhesion receptors, chemokines, and coactivating substances that activate inflammatory and coagulant cascades, likely play a critical role in the lung allograft response to ischemia and reperfusion. The platelet response to the pulmonary allograft, however, has never been studied. Here we report significant platelet activation immediately after lung transplantation.

Methods: We performed a prospective cohort study comparing markers of platelet activation in patients undergoing lung transplantation and patients undergoing nontransplant thoracotomy. Plasma levels of soluble P-selectin, soluble CD40 ligand, and platelet–leukocyte conjugates were measured before surgery, after skin closure, and at 6 postoperative hours.

Results: Both soluble P-selectin and soluble CD40 ligand levels increased significantly after lung transplantation but not after thoracotomy. Additionally, platelet–monocyte conjugate fluorescence was significantly higher after lung transplantation than after thoracotomy alone.

Conclusion: These findings suggest that platelet activation is significantly increased after lung transplantation beyond that expected from the postoperative state. The increase in circulating platelet–monocyte conjugates suggests an important interaction between platelets and inflammatory cells. Further research should examine whether platelet activation affects early graft function after lung transplantation.

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