Surfactant replacement in reperfusion injury after clinical lung transplantation

Abstract

Background: Reperfusion injury remains a significant risk factor in the immediate postoperative course after lung transplantation. We report on our initial clinical experience of surfactant replacement in reperfusion injury after clinical lung transplantation. Methods and results: In 31 consecutive patients, lung (8 single lung, 16 bilateral lung) or heart-lung (7) transplantation was performed. In 6 patients, severe reperfusion injury developed and was treated with continuously nebulized surfactant. Compliance of the allograft increased 40 ± 25% within 3 h following treatment with surfactant. Alveolar arterial oxygen gradient decreased by 23 ± 11% after 3 h and by 35 ± 20% after 6 h. Normal graft function was reestablished within 1-3 days after transplantation. All treated recipients were extubated until the 6th postoperative day. The 30-day mortality for the 31 recipients was 3.3%, the 1-year survival 84%. Conclusions: Surfactant replacement may become a clinical method for treatment of reperfusion injury after lung transplantation.