title: Surfactant function in lung transplantation after 24 hours of ischemia: advantage of retrograde flush perfusion for preservation.
abstract: 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.
  
  
  CONCLUSIONS
  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.affiliation: Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. strueber@thg.mh-hannover.de
authors.forename: Martin
authors.initials: M
authors.lastname: Strüber
authors.forename: Jens M
authors.initials: JM
authors.lastname: Hohlfeld
authors.forename: Theo
authors.initials: T
authors.lastname: Kofidis
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
authors.forename: Jost
authors.initials: J
authors.lastname: Niedermeyer
authors.forename: Sebastian P
authors.initials: SP
authors.lastname: Sommer
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000818:Animals; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology; D002951:Citrates / Q000008:administration & dosage*; D015633:Extravascular Lung Water / Q000502:physiology; D005260:Female; D008168:Lung / Q000503:physiopathology*; D008170:Lung Compliance; D016040:Lung Transplantation; D009926:Organ Preservation; D019188:Organ Preservation Solutions / Q000008:administration & dosage*; D010477:Perfusion / Q000379:methods; D011652:Pulmonary Circulation; D011663:Pulmonary Surfactants / Q000502:physiology*; D015427:Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control; D013552:Swine; D014655:Vascular Resistance
chemical_list: D002951:Citrates; D019188:Organ Preservation Solutions; C070005:Perfadex; D011663:Pulmonary Surfactants