Bronchoscopic surfactant administration preserves gas exchange and pulmonary compliance after single lung transplantation in dogs

Abstract

Bronchoscopic surfactant administration does not prevent leukocyte influx or vascular leakage but does protect against respiratory failure and improves lung mechanics in single lung transplantation in dogs.

Beneficial effects of synthetic KL4surfactant in experimental lung transplantation

“…Likewise, neutrophil entry was observed in transplanted lungs. KL 4 surfactant treatment did not influence neutrophil influx into the grafts, which is consistent with previous studies using animal-derived surfactant [12].…”

“…In addition, KL 4 surfactant treatment prevented production of both lipid peroxides and protein carbonyls in the alveolar compartment, decreased CRP levels and normalised SP-A. In contrast, KL 4 surfactant treatment did not prevent or reduce plasma protein leakage and neutrophil influx into the alveolar space of the graft, as previously reported in other studies showing potential benefits of exogenous surfactant treatment in I/R injury after lung transplantation [11,12]. Interestingly, these lung injury sequelae (i.e.…”

“…The therapeutic dose we used for intratracheal administration of KL 4 surfactant (25 mg?kg body weight -1 ) to donor lungs is ,15% of the dose recommended for surfactant instillation in neonatal RDS (175 mg/kg bw), and much lower than that used for the treatment of patients with ARDS (100-300 mg?kg body weight -1 ) [19] and that previously used in experimental lung transplantation (50-200 mg?kg body weight -1 ) [8][9][10][11][12][13]. We found that a higher dose of KL 4 surfactant (65 mg?kg body weight -1 (2.5 mL?kg body weight -1 ) did not increase the beneficial effect of this synthetic surfactant (data not shown).…”

“…In various experimental [8][9][10][11][12][13] and clinical [14][15][16][17][18] lung transplantation studies, animal-derived surfactants have been administered at different times over the course of the injury, either to the donor (before ischaemia) [8,10,12,13,16] or to the recipient (before [9][10][11]17] or after [12][13][14][15]18] reperfusion). Animal-derived surfactants consist of lipid extract preparations obtained from either bovine or porcine sources [19].…”

Pre-ischaemic exogenous surfactant reduces pulmonary injury in rat ischaemia/reperfusion

“…Several experimental [12][13][14][15][16][17][18][19][20][21] and clinical [22][23][24] studies give evidence that exogenous surfactant therapy successfully supplements the imbalanced endogenous surfactant system, serving to attenuate I/R injury and effectively improve lung preservation and graft function [11]. The great advantage of exogenous surfactant therapy of the donor in human lung transplantation is the fact that PGD in this case can accurately be predicted and, thus, even be prevented, providing a promising approach for prophylactic surfactant therapy [11,25,26].…”