Controlled Reperfusion After Lung Ischemia: Implications For Improved Function After Lung Transplantation

Abstract

After 2 hours of warm pulmonary ischemia, (1) a severe lung injury occurs after uncontrolled reperfusion, (2) controlled reperfusion with either a modified reperfusion solution or white blood cell filter limits, but does not avoid, a lung reperfusion injury, (3) reperfusion using both a modified reperfusate and white blood cell filter results in complete preservation of pulmonary function. We therefore believe surgeons should control the reperfusate after lung transplantation to improve postoperative pulmonary function.

Report of the ISHLT Working Group on Primary Lung Graft Dysfunction Part IV: Recipient-Related Risk Factors and Markers

“…Shear stress leads to capillary leak and worse graft function. [37][38][39][40][41][42] In one series of patients with PPH or pulmonary arterial hypertension due to congenital heart disease, patients who underwent single-lung transplantation had a higher risk of early (Ͻ24-hour) pulmonary edema (82%) than patients who underwent bilateral lung transplantation (59%), supporting the role of shear stress. 43 In addition, patients who underwent heart-lung transplantation had an even lower risk (33%), suggesting a recipient cardiac contribution to PGD.…”

“…111 Experimental studies have shown that carefully controlled reperfusion with a modified reperfusate can result in improved lung function after transplantation. 39 In addition to neutrophil reduction and changes in the composition of the reperfusate, the duration of modified reperfusion and the reperfusion pressure can have a significant impact on the degree of the injury. 38,112 Many of the aspects of reperfusate modification that have been shown to be efficacious in experimental models are now being utilized in the clinical setting by investigators at UCLA.…”

Evaluation of Hypoxemia and Respiratory Failure in the Early Period After Lung Transplantation

“…5 Modified reperfusion techniques, including leukocyte depletion and modified reperfusate solution as well as alterations in the duration and pressure of reperfusion may also decrease risk of PGD. 67,68 Treatment of PGD Traditional Strategies. There is no consensus on treatment of PGD.…”

Current status of lung transplantation

“…Recently, the use of controlled reperfusion in combination with leukocyte depletion has shown promise as a preventative strategy [49][50][51][52][53][54][55]. LICK et al [56] reported a nonrandomised small series in humans utilising this technique with no reperfusion injury.…”