Document Detail

Ex vivo reconditioning of marginal donor lungs injured by acid aspiration.
MedLine Citation:
PMID:  18971096     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Injured lungs due to gastric acid aspiration may be rejected for transplantation because of the possibility of early graft dysfunction. We hypothesized that diluted surfactant administration during ex vivo perfusion would recondition the lungs injured by acid aspiration and permit their use as suitable grafts for transplantation. METHODS: Using a pig model, lung injury was induced with 5-ml/kg administration of a betaine-HCl/pepsin mixture via a flexible bronchoscope. After injury, animals were randomly assigned to three study groups (n = 6/group): saline lavage during ex vivo perfusion (control); surfactant lavage ex vivo (SL-Exvivo); and surfactant lavage before harvest (SL-Pre); and a normal group (n = 4), with no lung injury. Cold storage time was 3 hours. A volume of 10 ml/kg (4 mg/ml, 40 mg/kg) surfactant (Curosurf) was used for lavage. Bronchoalveolar lavage (BAL) was performed before and after injury and at the end of the experiment. Protein and neutrophil percentage in BAL were assessed. Hemodynamic and aerodynamic parameters were measured every 30 minutes during a 2-hour observation period. RESULTS: An approximately 50% decrease in Pao(2) was observed in all animals after injury. Ex vivo surfactant lavage resulted in lower pulmonary vascular resistance, lower oxygenation index and higher Pao(2)/Fio(2) ratio compared with the control group (p = 0.001, p = 0.0001 and p = 0.0001, respectively, according to analysis of variance for repeated measures). Wet-to-dry weight ratio was lower in the SL-Exvivo group compared with the control group (p = 0.015). BAL neutrophil percent at the end of the experiment differed significantly between control and all other groups (p < 0.05). CONCLUSION: Diluted surfactant lavage during ex vivo perfusion improves graft function of lungs injured by gastric acid aspiration.
Ilhan Inci; Luca Ampollini; Stephan Arni; Wolfgang Jungraithmayr; Demet Inci; Sven Hillinger; Boris Leskosek; Peter Vogt; Walter Weder
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Publication Detail:
Type:  Journal Article     Date:  2008-10-01
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  27     ISSN:  1557-3117     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-30     Completed Date:  2009-02-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1229-36     Citation Subset:  IM    
Division of Thoracic Surgery, University Hospital, University of Zurich, Switzerland.
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MeSH Terms
Betaine / toxicity
Gastric Acid / metabolism*
Hydrochloric Acid / toxicity
Lung / physiology
Lung Injury / chemically induced*,  etiology
Lung Transplantation / physiology*
Models, Animal
Oxygen / blood
Pepsin A / toxicity
Tissue Donors / statistics & numerical data*
Transplantation Conditioning / methods*
Vascular Resistance / physiology
Reg. No./Substance:
107-43-7/Betaine; 7647-01-0/Hydrochloric Acid; 7782-44-7/Oxygen; EC A

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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