The use of surfactant in lung transplantation.
BACKGROUND
Lung transplantation impairs surfactant activity, which may contribute to primary graft dysfunction (PGD). Prompted by studies in animals and a few reports in humans, this study sought to determine if the administration of surfactant during transplantation serves as an effective preventive measure.


METHODS
An open, randomized, controlled prospective design was used. Forty-two patients scheduled for single (n=38) or double (n=4) lung transplantation at a major tertiary medical center were randomly assigned to receive, or not, intraoperative surfactant treatment. In the treated group, bovine surfactant was administered at a dose of 20 mg phospholipids/kg through bronchoscope after the establishment of bronchial anastomosis. The groups were compared for oxygenation (PaO2/FiO2), chest X-ray findings, PGD grade, and outcome.


RESULTS
Compared with the untreated group, the patients who received surfactant were characterized by better postoperative oxygenation mean PaO2/FiO2 (418.8+/-123.8 vs. 277.9+/-165 mm Hg, P=0.004), better chest radiograph score, a lower PGD grade (0.66 vs. 1.86, P=0.005), fewer cases of severe PGD (1 patient vs. 12, P<0.05), earlier extubation (by 2.2 hr; 95% CI 1.1-4.3 hr, P=0.027), shorter intensive care unit stay (by 2.3 days; 95% CI 1.47-3.74 days, P=0.001), and better vital capacity at 1 month (61% vs. 50%, P=0.022). One treated and 2 untreated patients died during the first postoperative month.


CONCLUSIONS
Surfactant instillation during lung transplantation improves oxygenation, prevents PGD, shortens intubation time, and enhances early posttransplantation recovery. Further, larger studies are needed to assess whether surfactant should be used routinely in lung transplantation.
Amital
Anat
A
Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel.
Shitrit
David
D
Raviv
Yael
Y
Saute
Milton
M
Medalion
Benjamin
B
Bakal
Llana
L
Kramer
Mordechai R
MR
D000328:Adult; D000368:Aged; D000818:Animals; D002417:Cattle; D005260:Female; D006085:Graft Survival; D006801:Humans; D008171:Lung Diseases / Q000628:therapy*; D016040:Lung Transplantation / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D055031:Primary Graft Dysfunction; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D016896:Treatment Outcome
D011663:Pulmonary Surfactants; D010100:Oxygen