IL-1beta in bronchial lavage fluid is a non-invasive marker that predicts the viability of the pulmonary graft from the non-heart-beating donor.
BACKGROUND
Viability testing of the pulmonary graft retrieved from the non-heart-beating donor (NHBD) is mandatory for successful outcome after lung transplantation. Functional assessment by ex vivo reperfusion, however, remains a cumbersome procedure. In this study, therefore, we wanted to investigate the possible value of the proinflammatory cytokines interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) measured in bronchial lavage fluid (BLF) in predicting functional outcome of the pulmonary graft after reperfusion.


METHODS
Domestic pigs (29.9 +/- 0.56 kg) were sacrificed and divided in 5 groups (n = 5/group). In the non-ischemic group (NHBD-0), the heart-lung block was explanted immediately. In the other groups the animals were left untouched with increasing time intervals (1 hour = NHBD-1; 2 hours = NHBD-2; 3 hours = NHBD-3). Thereafter both lungs were cooled topically via chest drains up to a total ischemic interval of 4 hours. Finally, in the heart-beating donor group lungs were flushed and stored for 4 hours (4 degrees C) [HBD]. BLF samples were taken from the right lung in all groups after explantation for measurement of IL-1beta and TNF-alpha and the left lung was prepared for evaluation in an isolated reperfusion circuit. Haemodynamic, aerodynamic and oxygenation parameters were measured. Wet-to-dry weight ratio (W/D) was calculated after reperfusion.


RESULTS
Graft function deteriorated with increasing time intervals after death. A strong correlation was found between the increase of IL-1beta concentration measured in BLF and the increase in pulmonary vascular resistance (r = 0.80), mean airway pressure (r = 0.74) and wet-to dry weight ratio (r = 0.78); (p < 0.0001, for all parameters). No significant differences in TNF-alpha levels in BLF were observed amongst groups (p = 0.933).


CONCLUSIONS
IL-1beta in BLF prior to reperfusion correlated well with graft function and may therefore be a useful, non-invasive marker that can predict the viability of the pulmonary graft from the NHBD.
Rega
Filip R
FR
Center for Experimental Surgery and Anesthesiology, Katholieke Universiteit Leuven, Leuven, Belgium.
Vanaudenaerde
Bart M
BM
Wuyts
Wim A
WA
Jannis
Nicole C
NC
Verleden
Geert M
GM
Lerut
Toni E
TE
Van Raemdonck
Dirk E M
DE
D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D001831:Body Temperature / Q000502:physiology; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D007375:Interleukin-1 / Q000378:metabolism*; D008168:Lung / Q000033:anatomy & histology / Q000378:metabolism; D016040:Lung Transplantation; D023421:Models, Animal; D008955:Models, Cardiovascular; D009926:Organ Preservation; D009929:Organ Size; D010100:Oxygen / Q000378:metabolism; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D013223:Statistics as Topic; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014655:Vascular Resistance / Q000502:physiology
D015415:Biomarkers; D007375:Interleukin-1; D014409:Tumor Necrosis Factor-alpha; D010100:Oxygen