Surfactant abnormalities after single lung transplantation in dogs: impact of bronchoscopic surfactant administration.
OBJECTIVE
Disturbances of the alveolar surfactant system have been implicated in the pathogenesis of reperfusion injury. The aim of this study was to evaluate the influence of exogenous surfactant administration on surfactant properties in a model of single lung transplantation.


METHODS
We performed heterologous, left lung transplantation (+4 degrees C ischemia; 24 hours, Euro-Collins solution) in 6 foxhounds (untreated) and in 6 animals that received calf lung surfactant extract (Alveofact) prior to explantation (only donor lung; 50 mg/kg body weight) and immediately after onset of reperfusion (both lungs, 200 mg/kg body weight). Separate but synchronized ventilation of each lung was performed, in a volume-controlled, pressure-limited mode, with animals in prone position. Bronchoalveolar lavage fluids were collected in pretransplantation lungs (control), after 24 hours of ischemia prior to transplantation (0 hours) and 6 and 12 hours after reperfusion in both the grafts and the recipient native lungs.


RESULTS
Ischemic storage per se did not provoke any changes of the surfactant system; however, severe alterations occurred within 6 hours of reperfusion, resulting in a severe loss of surface activity, including a decrease in the percentage of the large surfactant aggregate fraction, reduction of the surfactant apoproteins SP-B and SP-C, the dipalmitoyl molecular species of phosphatidylcholine and phosphatidylglycerol within the large surfactant aggregate fraction. These abnormalities were restricted to the graft, with virtually normal surfactant function and composition being found in the recipient native lung. Surfactant administration fully normalized the biochemical and largely improved the biophysical surfactant properties, alongside maintenance of lung gas exchange properties.


CONCLUSIONS
Severe surfactant abnormalities occur exclusively in the graft when performing separate, synchronized ventilation of each lung to attenuate ventilator-induced lung injury. Bronchoscopic surfactant administration provides protection against these abnormalities and may be a therapeutic strategy in lung transplantation.
Günther
Andreas
A
Department of Internal Medicine, Justus Liebig University, Giessen, Germany.
Balser
Markus
M
Schmidt
Reinhold
R
Markart
Philipp
P
Olk
Alexander
A
Börgermann
Jochen
J
Splittgerber
Fred H
FH
Seeger
Werner
W
Friedrich
Ivar
I
D000818:Animals; D001059:Apoproteins / Q000008:administration & dosage; D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D001999:Bronchoscopy; D004195:Disease Models, Animal; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D005260:Female; D008055:Lipids / Q000008:administration & dosage; D016040:Lung Transplantation; D008297:Male; D008954:Models, Biological; D010743:Phospholipids / Q000008:administration & dosage / Q000378:metabolism; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D011506:Proteins / Q000378:metabolism; D011650:Pulmonary Alveoli / Q000002:abnormalities* / Q000187:drug effects / Q000503:physiopathology; D037661:Pulmonary Surfactant-Associated Proteins / Q000008:administration & dosage; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D015427:Reperfusion Injury / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013500:Surface Tension / Q000187:drug effects; D013997:Time Factors; D014183:Transplantation, Heterologous
D001059:Apoproteins; D015415:Biomarkers; D008055:Lipids; D010743:Phospholipids; D011506:Proteins; D037661:Pulmonary Surfactant-Associated Proteins; D011663:Pulmonary Surfactants; C078272:SF-RI 1, bovine surfactant preparation; C046616:pulmonary surfactant apoprotein