Potential Role for Pulmonary Surfactant in Lung Transplantation
Since its introduction in 1954 by Murray and colleagues, allotransplantation has greatly improved the quality, as well as the duration of life for those involved.1 The discovery of immunosuppressant drugs advanced long term efficacy of transplantation and led to a further improvement in the quality of life. Unfortunately, maximal potential benefits have never been achieved. As with a number of other organs, particularly kidneys, livers and hearts, there are lengthy waiting lists for suitable lungs. This lack of sufficient organs results, not only from the limited number of donors, but in part because many of the lungs available for transplant are judged unsuitable, due to edema, aspiration or contusion. The short period over which lungs remain clinically viable, presently 6–8 hours, also limits the availability of these organs. Furthermore, the practice of maintaining brain-damaged potential organ donors on respirators using high oxygen levels and vigorous mechanical ventilation contributes to the paucity of available lungs.
KeywordsCholesterol Surfactant Ischemia Attenuation Chloroform
Unable to display preview. Download preview PDF.
- 2.F. Possmayer, Physicochemical aspects of pulmonary surfactant, in: Fetal and Neonatal Physiology, R.A. Poulin and W.W. Fox, eds., WB Saunders Company, Boca Raton (1997). (in press)Google Scholar
- 3.R.J. King and J.A. Clements, Surface active materials from dog lung. II. Composition and physiological correlations, A m J Phys. 223:715 (1972).Google Scholar
- 7.L.M.G. van Golde, J.J. Batenburg and B. Robertson, The pulmonary surfactant system, Int Union Physiol SciJ/Am Physiol Soc. 9:13 (1994).Google Scholar
- 12.J.F. Lewis, J.S. Dhillon, R. Singh, C.C. Johnson and T.C. Frewen, Exogenous surfactant therapy for pediatric patients with the acute respiratory distress syndrome, Can Resp J. 4:21 (1997).Google Scholar
- 13.R.J. Novick, R.A.W. Veldhuizen, F. Possmayer, J. Lee, D. Sandler, and J.F. Lewis, Exogenous surfactant therapy in thirty-eight hour lung graft preservation for transplantation, J Thorac Cardiovasc Surg. 108:259 (1994).Google Scholar
- 19.M.E. Erasmus, A.H. Petersen, S.B. Oetomo and J. Prop, The function of surfactant is impaired during the reimplantation response in rat lung transplants, J Heart Lung Transplan. 13:791 (1994).Google Scholar
- 20.Novick, R.J., Gehman, K.E., Ali, LS., and Lee, J., 1996 Lung preservation — the importance of endothelial and alveolar type II cell integrity, Ann Thorac Surg. 62:302.Google Scholar
- 21.A. Günther, I. Friedrich, F.H. Splittgerber, J. Börgermann, M. Brinkmann, R. Schmidt, M. Yabut, C. Reidemeister and W. Seeger, Attenuation of reperfusion-induced alteration of surfactant properties by application of bovine surfactant extract in a model of single lung transplantation, Am J Resp Crit Care Med. 155: A214. (1991).Google Scholar