Controlled reperfusion and pentoxifylline modulate reperfusion injury after single lung transplantation.
OBJECTIVE
Rodent models have suggested that initial low-pressure reperfusion of transplanted lungs reduces injury after ischemia. We investigated this phenomenon and the use of pentoxifylline in a porcine model of left single lung transplantation.


METHODS
Donor lungs were preserved with Euro-Collins solution for a mean ischemic time of 18.4 hours. Neutrophil trapping in the graft, pulmonary artery pressure, and gas exchange were assessed over a 12-hour period. Partial occlusion of the contralateral pulmonary artery allowed manipulation of the pulmonary artery pressure in the transplanted lung. Group A (n = 5) was perfused at a mean pulmonary artery pressure of 20 mm Hg, group B was reperfused at a mean pulmonary artery pressure of 45 mm Hg for 10 minutes before reducing the pressure to the same as group A, and group C was reperfused at a mean pressure of 20 mm Hg for 10 minutes, then increased to a mean of 45 mm Hg for the remainder of the experiment. Group D was reperfused as in group A with the addition of intravenous pentoxifylline.


RESULTS
Leukocyte sequestration was observed in the first 10 minutes after reperfusion in groups A, B, and C, with maximal sequestration at 2 minutes. Significantly more sequestration was observed in the first 6 minutes in group B than in groups A and C, which were similar. Pentoxifylline significantly reduced leukocyte sequestration. Pulmonary venous oxygen tension in the allograft lung was worst in group B. Groups A and C were similar, but group D was superior to all other groups (p < 0.001).


CONCLUSIONS
Low-pressure reperfusion, even when limited to the first 10 minutes, modulates reperfusion injury possibly through a leukocyte-dependent mechanism. The addition of pentoxifylline in the recipient confers significant additional benefit.
Clark
S C
SC
Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Sudarshan
C
C
Khanna
R
R
Roughan
J
J
Flecknell
P A
PA
Dark
J H
JH
D000818:Animals; D001784:Blood Gas Analysis; D005260:Female; D005500:Follow-Up Studies; D008168:Lung / Q000098:blood supply*; D016040:Lung Transplantation / Q000502:physiology; D008315:Malondialdehyde / Q000378:metabolism; D009504:Neutrophils / Q000187:drug effects / Q000473:pathology; D010431:Pentoxifylline / Q000627:therapeutic use*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D015424:Reperfusion / Q000379:methods*; D015427:Reperfusion Injury / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control*; D013552:Swine; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D008315:Malondialdehyde; D010431:Pentoxifylline