Surfactant as salvage therapy in life threatening primary graft dysfunction in lung transplantation.
OBJECTIVE
Impaired surfactant activity may contribute to primary graft dysfunction after lung transplantation. We assessed the role of surfactant treatment in lung transplant recipients with severe life threatening primary lung graft dysfunction.


METHODS
Five patients after lung transplantation: 4 after single-lung transplantation, for emphysema (n=3) or idiopathic pulmonary fibrosis (n=1), and 1 patient after double-lung transplantation for cystic fibrosis. All had severe life threatening primary graft dysfunction that failed to respond to conventional measures. Treatment consisted of bronchoscopic instillation of mammalian surfactant, 20-90cc, at 3 (n=1) or 7 days (n=4) after transplantation.


RESULTS
There was a significant improvement in the ratio of partial arterial oxygen tension (PaO(2)) to fractional concentration of oxygen in inspired gas (FIO(2)), from a mean of 98.8+/-21.7 to 236.8+/-52.3 mmHg (p=0.0006), within hours of treatment. All were eventually discharged home and showed a satisfactory FEV(1) (44-67% predicted) at the 6-month follow-up. All patients were still alive 6 months or more after transplantation.


CONCLUSIONS
Surfactant treatment improves oxygenation and may be life saving in patients with primary lung graft dysfunction.
Amital
Anat
A
Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Shitrit
David
D
Raviv
Yael
Y
Saute
Milton
M
Bakal
Ilana
I
Medalion
Benjamin
B
Kramer
Mordechai R
MR
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D055031:Primary Graft Dysfunction / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D011859:Radiography; D016879:Salvage Therapy / Q000379:methods; D055815:Young Adult
D011663:Pulmonary Surfactants; D010100:Oxygen