Effect of cardiopulmonary bypass on early graft dysfunction in clinical lung transplantation

Aeba, Ryo; Griffith, Bartley P.; Kormos, Robert L.; Armitage, John; Gasior, Thomas A.; Fuhrman, Carl R.; Yousem, Samuel A.; Hardesty, Robert L.

doi:10.1016/0003-4975(94)90573-8

Cited by 115 publications

(68 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The inflammatory effects of acute hyperglycemia in this study correlate with published effects of stress-induced hyperglycemia in several models of experimental inflammation (27,(32)(33)(34)(35). Stress-induced hyperglycemia is also a well documented risk factor for morbidity and mortality among patients undergoing cardiothoracic care and transplant (33,(36)(37)(38).…”

Section: Discussionsupporting

confidence: 67%

Acute Hyperglycemic Exacerbation of Lung Ischemia–Reperfusion Injury Is Mediated by Receptor for Advanced Glycation End-Products Signaling

LaPar

Hajzus

Zhao

et al. 2012

Am J Respir Cell Mol Biol

View full text Add to dashboard Cite

The effects of acute hyperglycemia on lung ischemia-reperfusion (IR) injury and the role of receptor for advanced glycation endproducts (RAGE) signaling in this process are unknown. The objective of this study was twofold: (1) evaluate the impact of acute hyperglycemia on lung IR injury; and (2) determine if RAGE signaling is a mechanism of hyperglycemia-enhanced IR injury. We hypothesized that acute hyperglycemia worsens lung IR injury through a RAGE signaling mechanism. C57BL/6 wild-type (WT) and RAGE knockout (RAGE 2/2 ) mice underwent sham thoracotomy or lung IR (1-h left hilar occlusion and 2-h reperfusion). Acute hyperglycemia was established by dextrose injection 30 minutes before ischemia. Lung injury was assessed by measuring lung function, cytokine expression in bronchoalveolar lavage fluid, leukocyte infiltration, and microvascular permeability via Evans blue dye. Mean blood glucose levels doubled in hyperglycemic mice 30 minutes after dextrose injection. Compared with IR in normoglycemic mice, IR in hyperglycemic mice significantly enhanced lung dysfunction, cytokine expression (TNF-a, keratinocyte chemoattractant, IL-6, monocyte chemotactic protein-1, regulated upon activation, normal T cell expressed and secreted), leukocyte infiltration, and microvascular permeability. Lung injury and dysfunction after IR were attenuated in normoglycemic RAGE 2/2 mice, and hyperglycemia failed to exacerbate IR injury in RAGE 2/2 mice. Thus, this study demonstrates that acute hyperglycemia exacerbates lung IR injury, whereas RAGE deficiency attenuates IR injury and also prevents exacerbation of IR injury in an acute hyperglycemic setting. These results suggest that hyperglycemia-enhanced lung IR injury is mediated, at least in part, by RAGE signaling, and identifies RAGE as a potential, novel therapeutic target to prevent post-transplant lung IR injury.Keywords: lung transplant; receptor for advanced glycation end-products; hyperglycemia; inflammation Ischemia-reperfusion (IR) injury remains a leading cause of morbidity and mortality among patients undergoing lung transplantation. IR injury entails a rapid inflammatory response upon transplantation resulting in activation of the innate immune system, expression of proinflammatory cytokines, leukocyte infiltration, and edema, all of which contribute to subsequent acute graft failure. With a reported incidence of 25-30%, IR injury results in increased resource utilization, including prolonged mechanical ventilation, intensive care unit duration, and overall hospital lengths of stay (1, 2). Moreover, IR injury has also been identified as an important clinical risk factor for the development of chronic graft rejection in the form of bronchiolitis obliterans (3). As a result, studies aimed toward the development of therapeutic strategies to combat this complication hold tremendous clinical value.The receptor for advanced glycation end-products (RAGE) is a ubiquitous, multiligand receptor implicated in a variety of pathological conditions, such as diabetes and its compli...

show abstract

Section: Discussionsupporting

confidence: 67%

Acute Hyperglycemic Exacerbation of Lung Ischemia–Reperfusion Injury Is Mediated by Receptor for Advanced Glycation End-Products Signaling

LaPar

Hajzus

Zhao

et al. 2012

Am J Respir Cell Mol Biol

View full text Add to dashboard Cite

show abstract

“…[147][148][149][150][151] Con el aumento progresivo del trasplante pulmonar bilateral secuencial y la mejora en la técnica quirúrgica, las indicaciones para la CEC en el TP han disminuido.…”

Section: Influencia De La Cec En El Trasplante Pulmonarunclassified

“…También dichos autores describen una mayor incidencia de daño alveolar difuso en las biopsias pulmonares. 149 Sin embargo, otros autores no encuentran dichas diferencias en cuanto al tiempo de VM y el tiempo de ingreso en UCI como Szeto y cols que no encuentran dichas diferencias en el tiempo de VM (p = 0,76) ni en el tiempo de estancia en UCI (p= 0,44). 169 El uso de CEC durante el TP también se ha definido como factor de riesgo independiente para VM prolongada posterior al TP en la serie publicada por Gammie y cols en base a 94 pacientes que recibieron un TBP (p = 0,0004, OR 6,2).…”

Section: Influencia De La Cecunclassified

“…Esto es común a todos los pacientes que requieren CEC (no solo los pacientes de TP), y diversos estudios relacionan la CEC con una mayor activación de la respuesta inflamatoria y un aumento en la frecuencia de disfunción primaria del injerto (DPI) pulmonar. [148][149][150][154][155][156][157][158] Un metanálisis de 11 estudios demuestra que la incidencia de DPI era significativamente mayor en los pacientes trasplantados pulmonares bajo CEC, atribuyendo un riesgo de 2.29 mayor de DPI si se trasplantan bajo CEC. 155 Khan y cols 159 reportan una serie de 99 pacientes trasplantados, en los cuales estudian los posibles factores relacionados con la DPI y concluyen que la utilización de CEC durante el TP se asocia con un aumento en la incidencia y gravedad de la DPI, lo cual aumentaba el tiempo de ventilación mecánica (VM) y la estancia en la unidad de cuidados intensivos (UCI) pero que no afectaba la supervivencia.…”

unclassified

See 1 more Smart Citation

El trasplante pulmonar en la fibrosis quística y la influencia de la circulación extracorpórea

Deu

Romero

Román

et al. 2018

Archivos de Bronconeumología

View full text Add to dashboard Cite

“…Thus, extracorporeal circulation support may be quite commonly required in the form of CPB or extracorporeal membrane oxygenation (ECMO). CPB during pulmonary transplantation increases the risks of early graft dysfunction and bleeding (26)(27)(28). The impact of ECMO on blood loss needs to be established.…”

Section: Predictors Of Blood Loss During Lung Transplantationmentioning

confidence: 99%

Established and potential predictors of blood loss during lung transplant surgery

et al. 2018

View full text Add to dashboard Cite

Lung transplantation is an established therapeutic procedure for end stage lung diseases. Its success may be impaired by perioperative complications. Intraoperative blood loss and the resulting blood transfusion are among the most common complications. The various factors contributing to increased blood loss during lung transplantation are only scarcely investigated and not yet completely understood. This is in sharp contrast to other surgical fields, as in orthopedic surgery, liver transplantation and cardiac surgery the contributors to blood loss are well identified. This narrative review article aims to highlight the acknowledged factors influencing blood loss in lung transplantation (such as double vs. single lung transplant) and to discuss potential factors that may be of interest for further research or helpful to develop strategies targeting risk factors in order to minimize blood loss during lung transplantation and finally improve patient outcome.

show abstract

Effect of cardiopulmonary bypass on early graft dysfunction in clinical lung transplantation

Cited by 115 publications

References 18 publications

Acute Hyperglycemic Exacerbation of Lung Ischemia–Reperfusion Injury Is Mediated by Receptor for Advanced Glycation End-Products Signaling

Acute Hyperglycemic Exacerbation of Lung Ischemia–Reperfusion Injury Is Mediated by Receptor for Advanced Glycation End-Products Signaling

El trasplante pulmonar en la fibrosis quística y la influencia de la circulación extracorpórea

Established and potential predictors of blood loss during lung transplant surgery

Contact Info

Product

Resources

About