title: Surfactant as salvage therapy in life threatening primary graft dysfunction in lung transplantation.
abstract: 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.
authors.affiliation: Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Amital
authors.forename: David
authors.initials: D
authors.lastname: Shitrit
authors.forename: Yael
authors.initials: Y
authors.lastname: Raviv
authors.forename: Milton
authors.initials: M
authors.lastname: Saute
authors.forename: Ilana
authors.initials: I
authors.lastname: Bakal
authors.forename: Benjamin
authors.initials: B
authors.lastname: Medalion
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
mesh_terms: 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
chemical_list: D011663:Pulmonary Surfactants; D010100:Oxygen