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J Thorac Cardiovasc Surg 2002;123:3-5
© 2002 The American Association for Thoracic Surgery

Editorials

Innovative techniques to enhance lung preservation

From the Department of Cardiac Surgery, London Health Science Center, London, Ontario, Canada.

Received for publication Aug 7, 2001. Accepted for publication Sept 13, 2001. Address for reprints: Richard J. Novick, MD, Chief, Division of Cardiac Surgery, London Health Science Center, Room D228, NR SSC Satellite Office, London, Ontario N6A 4G5, Canada.

See related article on page 98.

In this issue of the Journal, Strüber and associates ¹ report the results of a series of experiments comparing the effect of retrograde versus antegrade perfusion of lung grafts on oxygenation, compliance, and surfactant function in a porcine model. The Hannover group has a venerable track record of conducting innovative research in lung preservation and was the first to report the use of exogenous surfactant therapy to treat ischemia-reperfusion injury after clinical lung transplantation. ² The current article will add to the burgeoning field of research on new methods of lung preservation designed to decrease post-transplant graft dysfunction and potentially enlarge the donor pool.

Lung preservation as a rate-limiting step to lung transplantation

A shortage of suitable lung grafts has been a major rate-limiting step in clinical lung transplantation during the past decade. The majority of prospective donor lungs exhibit hypoxemia and pulmonary infiltrates due to edema, aspiration, and pneumonia associated with the effects of brain death and the need for ventilatory support in organ donors. ³ Recent work has confirmed that some lung grafts previously deemed unsuitable can in fact be transplanted successfully. ⁴ Nevertheless, most such grafts will still be too compromised to permit successful harvesting for transplantation. New methods to rescue these grafts or mitigate ischemia-reperfusion injury after transplantation will go a long way toward reducing the supply-demand imbalance that currently plagues clinical lung transplantation.

Pulmonary surfactant and lung preservation

An interesting feature of Strüber and associates' article is a study of the impact of different techniques of lung graft flushing on the pulmonary surfactant system. Surfactant is a lipid-protein complex produced by type II pneumocytes, which stabilizes the lung by reducing surface tension at the alveolar-pulmonary capillary interface. ⁵ Surfactant recovered by bronchoalveolar lavage consists of subfractions differing in morphologic appearance and buoyant density. The heavy subtype or surfactant . . . [Full Text of this Article]

Related Article

Surfactant function in lung transplantation after 24 hours of ischemia: Advantage of retrograde flush perfusion for preservation

Martin Strüber, Jens M. Hohlfeld, Theo Kofidis, Gregor Warnecke, Jost Niedermeyer, Sebastian P. Sommer, and Axel Haverich
J. Thorac. Cardiovasc. Surg. 2002 123: 98-103. [Abstract] [Full Text] [PDF]

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