OBJECTIVE: Surfactant function was shown to be impaired in clinical and experimental lung transplantation. This study was designed to define the impact of retrograde flush perfusion on graft and surfactant function after an extended period of ischemia. METHODS: Left lung transplantation was performed after 24 hours of graft ischemia in 12 pigs. In half of the grafts antegrade cold flush perfusion (Perfadex) was used for preservation. In the second group grafts were flushed in a retrograde fashion via the left atrium. Graft function was monitored for 7 hours after transplantation. Before transplantation (basal) and after 2 hours of reperfusion, bronchoalveolar lavage fluid was obtained. Minimal surface tension of bronchoalveolar lavage fluid was determined and the ratio of small and large surfactant aggregates was calculated. Lung water content was analyzed online in the reperfusion period. RESULTS: Right-sided heart failure developed in 2 animals of group 1 (antegrade perfusion) within 2 and 4.5 hours of reperfusion, respectively. All other pigs survived the observation period. PO(2)/FIO(2) (P =.001) and dynamic lung compliance (P =.001) were superior in retrogradely flushed grafts. A comparable increase of minimal surface tension was found after reperfusion in both groups. Small/large surfactant aggregate ratio after reperfusion (P =.03), as well as extravascular lung water content, was higher in the antegrade perfusion group. CONCLUSION: Retrograde flush perfusion for 24-hour lung preservation with low-potassium dextran (Perfadex) solution led to better initial graft function than the standard antegrade perfusion technique. A moderate impairment of surfactant function was found in both groups, which was more pronounced in the antegrade perfusion group.
OBJECTIVE: Surfactant function was shown to be impaired in clinical and experimental lung transplantation. This study was designed to define the impact of retrograde flush perfusion on graft and surfactant function after an extended period of ischemia. METHODS: Left lung transplantation was performed after 24 hours of graft ischemia in 12 pigs. In half of the grafts antegrade cold flush perfusion (Perfadex) was used for preservation. In the second group grafts were flushed in a retrograde fashion via the left atrium. Graft function was monitored for 7 hours after transplantation. Before transplantation (basal) and after 2 hours of reperfusion, bronchoalveolar lavage fluid was obtained. Minimal surface tension of bronchoalveolar lavage fluid was determined and the ratio of small and large surfactant aggregates was calculated. Lung water content was analyzed online in the reperfusion period. RESULTS: Right-sided heart failure developed in 2 animals of group 1 (antegrade perfusion) within 2 and 4.5 hours of reperfusion, respectively. All other pigs survived the observation period. PO(2)/FIO(2) (P =.001) and dynamic lung compliance (P =.001) were superior in retrogradely flushed grafts. A comparable increase of minimal surface tension was found after reperfusion in both groups. Small/large surfactant aggregate ratio after reperfusion (P =.03), as well as extravascular lung water content, was higher in the antegrade perfusion group. CONCLUSION: Retrograde flush perfusion for 24-hour lung preservation with low-potassium dextran (Perfadex) solution led to better initial graft function than the standard antegrade perfusion technique. A moderate impairment of surfactant function was found in both groups, which was more pronounced in the antegrade perfusion group.
Authors: Frederick R Adler; Paul Aurora; David H Barker; Mark L Barr; Laura S Blackwell; Otto H Bosma; Samuel Brown; D R Cox; Judy L Jensen; Geoffrey Kurland; George D Nossent; Alexandra L Quittner; Walter M Robinson; Sandy L Romero; Helen Spencer; Stuart C Sweet; Wim van der Bij; J Vermeulen; Erik A M Verschuuren; Elianne J L E Vrijlandt; William Walsh; Marlyn S Woo; Theodore G Liou Journal: Proc Am Thorac Soc Date: 2009-12
Authors: Michael S Mulligan; David Weill; R Duane Davis; Jason D Christie; Farhood Farjah; Jonathan P Singer; Matthew Hartwig; Pablo G Sanchez; Daniel Kreisel; Lorraine B Ware; Christian Bermudez; Ramsey R Hachem; Michael J Weyant; Cynthia Gries; Jeremiah W Awori Hayanga; Bartley P Griffith; Laurie D Snyder; Jonah Odim; J Matthew Craig; Neil R Aggarwal; Lora A Reineck Journal: J Thorac Cardiovasc Surg Date: 2018-08-18 Impact factor: 5.209
Authors: Katharina Jansson; Karla Dreckmann; Wiebke Sommer; Murat Avsar; Jawad Salman; Thierry Siemeni; Ann-Kathrin Knöfel; Linda Pauksch; Jens Gottlieb; Jörg Frühauf; Martin Werner; Danny Jonigk; Martin Strüber; Axel Haverich; Gregor Warnecke Journal: Transplant Direct Date: 2017-06-06