The role of leukodepletion in limiting ischemia/reperfusion damage in the heart, lung and lower extremity.

This article describes the experimental infrastructure and subsequent clinical application of a comprehensive reperfusion strategy to limit the injury following ischemia, resulting in an improvement in post operative organ function. In particular, it examines the role of luekodepletion in minimizing damage and improving functional outcome in the heart, lung and lower extremity. During cardiothoracic procedures, various organs can be subjected to temporary ischemia, particularly the heart (cardioplegic arrest), lung (transplant), and lower extremity (femoral canulation, IABP). The background of ischemia/reperfusion injury is discussed as it applies to each of these 3 organs, as well as findings that ischemia followed by reperfusion results in a similar injury in each organ. Data are then presented to demonstrate that a comprehensive reperfusion strategy, utilizing a modified substrate-enriched blood reperfusate delivered at a low pressure can limit this injury, and that adding white blood cell filtration significantly improves the efficacy of this approach. These principles have now been used in a series of patients undergoing various surgical procedures with excellent results. Application of these concepts may significantly improve the outcome in patients undergoing procedures which subject these organs to temporary ischemia.