Leukocyte filtration in lung transplantation

Abstract

Controlled reperfusion of the transplanted lung has been used in nine consecutive patients to decrease manifestations of lung reperfusion injury. An extracorporeal circuit containing a roller pump, heat exchanger and leukodepleting filter is primed with substrate-enhanced reperfusion solution mixed with approximately 2000 ml of the patient's blood. This solution is slowly recirculated to remove leukocytes prior to reperfusion. When the pulmonary anastomoses are completed, the pulmonary artery is cannulated through the untied anastomosis using a catheter containing a pressure lumen for measurement of infusion pressure. An atrial clamp is left in place on the patient's native atrial cuff to decrease the risk of systemic air embolism during the brief period of reperfusion from the extracorporeal reservoir. During reperfusion, the water bath to the heat exchanger is kept at 35 degrees C and the flow rate for reperfusion solution is between 150 and 200 m/min, keeping the pulmonary artery pressure <14 mmHg. Eight of nine patients were ventilated on 40% inspired oxygen within a few hours of operation and 7/9 were extubated on or before postoperative day 1. Six of nine patients are long-term survivors.

Length of pressure-controlled reperfusion is critical for reducing ischaemia-reperfusion injury in an isolated rabbit lung model

“…The intrapulmonary leukocyte pool and blood leukocytes are considered as a trigger of IR-injury [ 24 , 44 - 46 ]. Although many investigations have confirmed the role of neutrophils in reperfusion injury [ 9 , 24 , 44 , 47 ], other have questioned neutrophil involvement [ 48 ]. One report of Fiser et al could show that in the earliest phase of reperfusion injury the donor (resident) pulmonary leukocyte pool plays an important role [ 46 ].…”

“…Despite the documented effectiveness of this approach after myocardial ischaemia [ 20 ] or ischaemia of the lower extremities [ 20 , 21 ] equivalent data about controlled reperfusion of the lungs are rare. In other reports beneficial effects of controlled reperfusion by changing the compounds of the first line perfusate solution [ 22 , 23 ] and leukocyte depletion [ 9 , 22 , 24 ] were described. In rats [ 25 ] and in rabbits [ 26 ] it was reported that PCR improved lung function after ischaemia.…”

The role of leukocyte depletion in ex vivo evaluation of pulmonary grafts from (non-)heart-beating donors

“…34 Many authors confirmed these findings in experimental settings. 35 ¡ 37 Lick et al 38 and Kurusz et al 39 described the importance of this technique when used in humans.…”