Platelet activation in the postoperative period after lung transplantation.
OBJECTIVE
During lung transplantation, cells in the pulmonary parenchyma are subjected to ischemia, hypothermic storage, and reperfusion injury. Platelets, whose granular contents include adhesion receptors, chemokines, and coactivating substances that activate inflammatory and coagulant cascades, likely play a critical role in the lung allograft response to ischemia and reperfusion. The platelet response to the pulmonary allograft, however, has never been studied. Here we report significant platelet activation immediately after lung transplantation.


METHODS
We performed a prospective cohort study comparing markers of platelet activation in patients undergoing lung transplantation and patients undergoing nontransplant thoracotomy. Plasma levels of soluble P-selectin, soluble CD40 ligand, and platelet-leukocyte conjugates were measured before surgery, after skin closure, and at 6 postoperative hours.


RESULTS
Both soluble P-selectin and soluble CD40 ligand levels increased significantly after lung transplantation but not after thoracotomy. Additionally, platelet-monocyte conjugate fluorescence was significantly higher after lung transplantation than after thoracotomy alone.


CONCLUSIONS
These findings suggest that platelet activation is significantly increased after lung transplantation beyond that expected from the postoperative state. The increase in circulating platelet-monocyte conjugates suggests an important interaction between platelets and inflammatory cells. Further research should examine whether platelet activation affects early graft function after lung transplantation.
Sternberg
David I
DI
Lung Transplant Program, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Shimbo
Daichi
D
Kawut
Steven M
SM
Sarkar
Joydeep
J
Hurlitz
Georg
G
D'Ovidio
Frank
F
Lederer
David J
DJ
Wilt
Jessie S
JS
Arcasoy
Selim M
SM
Pinsky
David J
DJ
D'Armiento
Jeanine M
JM
Sonett
Joshua R
JR
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D023201:CD40 Ligand / Q000378:metabolism*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019007:P-Selectin / Q000378:metabolism*; D015539:Platelet Activation / Q000502:physiology*; D011184:Postoperative Period; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods
D015415:Biomarkers; D019007:P-Selectin; D023201:CD40 Ligand