Purpose: Ischemia-reperfusion injury (IRI) still significantly contributes to morbidity after lung transplantation. The endo-bronchial administration of exogenous surfactant (ES) is a promising technique to mitigate its adverse effects. In this study we tested different timings of ES administration in a swine model of lung transplantation. Methods and Materials: Domestic Golan pigs underwent single left lung allo-transplantation after 24 hrs of cold ischemic preservation of the graft. Poractant alfa (Curosurf®, Chiesi Pharma) was administered at the dose of 30 mg/kg in the left lung trough a flexible bronchoscope. Animals were divided in four groups: A- ES given in the donor before cross-clamp and pulmonary perfusion; B- ES given into the graft’s airway before cold storage; C- ES given after reperfusion of the graft; D - control. After transplantation, the contra-lateral (right) pulmonary artery and bronchus were clamped and ventilatory and respiratory parameters were monitored for 6 hours at 30-minutes time points. Results: A trend in increased survival of the animals was observed in group B (83% vs. 75% (A), 63% (C), 50% (D)). Pulmonary peak pressures (PIP) were significantly reduced in groups A, B and C vs D (by a 0.477, 1,030, 0.847 factor at each observation point in group A, B, and C respectively, p 0.001), resulting in increased pulmonary compliance. Ox- ygenation (PaO2/FiO2 ratio) was significantly improved in group B at all observation time-points (with a mean increase of 199 mmHg, p 0.001) compared to controls. The severity of histologic damage, expressed by a semi-quantitative assessment score, was significantly less in group B com- pared to controls. Conclusions: Administration of ES in the lung graft during the cold pres- ervation period can result in significantly improved lung function (oxygen- ation, pulmonary compliance) and less severe histologic changes after lung transplantation in a swine model with 24 hrs ischemia.The study was supported by a grant from Chiesi Pharmaceutics.
The Administration of Exogenous Surfactant during Cold Preservation Can Improve Pulmonary Function after Lung Transplantation in a Swine Model of Prolonged Ischemia
Bertani A;
2012-01-01
Abstract
Purpose: Ischemia-reperfusion injury (IRI) still significantly contributes to morbidity after lung transplantation. The endo-bronchial administration of exogenous surfactant (ES) is a promising technique to mitigate its adverse effects. In this study we tested different timings of ES administration in a swine model of lung transplantation. Methods and Materials: Domestic Golan pigs underwent single left lung allo-transplantation after 24 hrs of cold ischemic preservation of the graft. Poractant alfa (Curosurf®, Chiesi Pharma) was administered at the dose of 30 mg/kg in the left lung trough a flexible bronchoscope. Animals were divided in four groups: A- ES given in the donor before cross-clamp and pulmonary perfusion; B- ES given into the graft’s airway before cold storage; C- ES given after reperfusion of the graft; D - control. After transplantation, the contra-lateral (right) pulmonary artery and bronchus were clamped and ventilatory and respiratory parameters were monitored for 6 hours at 30-minutes time points. Results: A trend in increased survival of the animals was observed in group B (83% vs. 75% (A), 63% (C), 50% (D)). Pulmonary peak pressures (PIP) were significantly reduced in groups A, B and C vs D (by a 0.477, 1,030, 0.847 factor at each observation point in group A, B, and C respectively, p 0.001), resulting in increased pulmonary compliance. Ox- ygenation (PaO2/FiO2 ratio) was significantly improved in group B at all observation time-points (with a mean increase of 199 mmHg, p 0.001) compared to controls. The severity of histologic damage, expressed by a semi-quantitative assessment score, was significantly less in group B com- pared to controls. Conclusions: Administration of ES in the lung graft during the cold pres- ervation period can result in significantly improved lung function (oxygen- ation, pulmonary compliance) and less severe histologic changes after lung transplantation in a swine model with 24 hrs ischemia.The study was supported by a grant from Chiesi Pharmaceutics.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
