Surfactant analysis and replacement therapy: a future tool of the lung transplant surgeon?

From 1965 to 1974 extensive research was carried out concerning the effects of experimental lung reimplantation and allografting on the surface tension properties of pulmonary surfactant. Since then, surfactant has been more rigorously examined in terms of its composition and function, and the potential roles of three surfactant-associated proteins have been established. Furthermore, surfactant replacement therapy for neonatal respiratory distress syndrome has come of age. The efficacy of surfactant treatment for adult respiratory distress syndrome is currently under clinical scrutiny, and experimental work on alterations in surfactant after lung transplantation has resumed after a 15-year hiatus. This article reviews current knowledge of the pulmonary surfactant system, as well as previous studies of the changes in surfactant after experimental lung transplantation. The experience in surfactant replacement therapy for the neonatal and adult respiratory distress syndromes is briefly described. Suggestions are made concerning the potential experimental and clinical applications of surfactant analysis and replacement therapy in lung transplantation.