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HEME OXYGENASE

Donor Lung Pretreatment with Surfactant in Experimental Transplantation Preserves Graft Hemodynamics and Alveolar Morphology

E. Koletsis^*,1, A. Chatzimichalis, V. Fotopoulos^*, K. Kokkinis, E. Papadimitriou, D. Tiniakos^¶, E. Marinos^¶, I. Bellenis and D. Dougenis^*

^* Department of Cardiothoracic Surgery, Patras University School of Medicine, Patras, Greece 26500;
Department of Angio-thoracic Surgery, Evangelismos General Hospital, Athens, Greece 10676;
Department of Anaesthesia and Intensive Care, Patras University School of Medicine, Patras, Greece 26500;
Patras University School of Pharmacy, Patras, Greece 26500; and
^¶ Laboratory of Histology & Embryology, Medical School, University of Athens, Goudi, Athens, Greece 11527

Abstract

In experimental lung transplantation, the reduction of endogenous surfactant properties occurs after graft preservation and transplant reperfusion. The aim of this study was to evaluate the efficacy of donor lung pretreatment with exogenous surfactant on graft damage after ischemia and reperfusion. Fourteen (control group A, n = 8; study group B,n= 6) young female white pigs (mean weight 27 ± 3.5 kg) were used in a newly developed autotransplantation model within situcold ischemia. In study group B, before thoracotomy, 1.5 ml/kg surfactant apoprotein-A-free surfactant was administrated into the left main bronchus via flexible bronchoscopy. Belzer UW solution was used for lung preservation. Cold ischemia was achieved for 3 hr with interlobar lung parenchyma temperature at 8 ± 1.3°C, and central temperature maintained at 37.20 ± 0.5°C. Animals were sacrificed after 3 hr of graft reperfusion. At the end of reperfusion, pulmonary vascular resistance index (was 447.80 dyn/sec.cm⁵.m²(±66.8) in group A vs 249.51 in group B (P< 0.001) and serum nitric oxide was adequately preserved. The mean alveolar surface area estimated by computerized morphometry was 5280.84 (4991.1) µm²(group A) vs 3997.89 (3284.70) µm²(group B;P< 0.005). Histology revealed milder macrophage and lymphocyte infiltration in group B at the end of reperfusion. Pretreatment of donor lung with an surfactant apoprotein-A -free surfactant agent appears to be beneficial in terms of maintaining serum NO and reducing hemodynamic disturbances. Furthermore, alveolar histology and stereomorphology are better preserved.

Key Words: lung transplantation • surfactant • nitric oxide • SP-A • experimental reperfusion injury

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