Effects of exogenous surfactant instillation in clinical lung transplantation:: A prospective, randomized trial
Effects of exogenous surfactant instillation in clinical lung transplantation:: A prospective, randomized trial
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DOI：
10.1016/j.jtcvs.2006.12.057
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发表时间：
2007-06-01
影响因子：
6
通讯作者：
Hohlfeld, Jens M.
中科院分区：
文献类型：
--
作者：
Strueber, Martin;Fischer, Stefan;Hohlfeld, Jens M.
目的：尽管在临床肺移植中引入了以低钾为基础的保存策略，但高达20%的肺移植后病例发生了相关的早期移植物功能障碍。这通常与灌注后表面活性剂功能障碍有关。我们进行了一项随机、前瞻性研究，研究外源性表面活性剂注入人供体肺对移植后表面活性剂功能和临床结果的影响。方法：15例供肺经支气管镜取肺前灌注外源性表面活性剂。支气管肺泡灌洗液于灌注前及移植后24小时取。评估支气管肺泡灌洗液的表面活性物质功能、磷脂和蛋白质含量，并前瞻性记录临床数据。肺移植术后4周进行肺功能检查。此外，在肺移植后一年内确定了1秒内的最佳用力呼气量。对照组14例患者接受供体肺，无表面活性物质滴注。进一步将肺功能测试结果与154例未参与本研究的连续双侧肺移植受体（历史对照）的结果进行比较。结果：肺移植术后1年内无死亡病例发生。供体肺表面活性物质功能在采收前正常范围内。对照组再灌注后表面活性物质功能明显受损。表面活性剂的替代显著改善了这一性能。表面活性剂组支气管肺泡灌洗液蛋白含量明显降低，表明肺泡毛细血管膜渗漏较少。表面活性剂组4周后1 s用力呼气量显著高于对照组（P = 0.034, P < 0.05）。分别为01)。有趣的是，两组肺移植后第一年的最佳1秒用力呼气量明显高于肺移植后4周检查时的用力呼气量（P = 0.01）。移植后4周，对照组患者1秒内的最佳用力呼气量与肺表面活性剂组相当。结论：本研究提示取肺前给肺注入外源性表面活性剂对肺移植后表面活性剂功能和早期临床预后有保护作用。这种方法可能有助于改善未来肺移植后的预后。
Objective: Despite the introduction of low potassium-based preservation strategies for clinical lung transplantation, relevant early graft dysfunction occurs in up to 20% of cases after lung transplantation. This was found to be frequently associated with postreperfusion surfactant dysfunction. We performed a randomized, prospective study investigating the effect of exogenous surfactant instillation into human donor lungs on posttransplant surfactant function and on clinical outcome.Methods: Exogenous surfactant was instilled into 15 donor lungs before retrieval via bronchoscopy. Bronchoalveolar lavage fluids were taken before instillation as well as 24 hours after transplantation. Surfactant function, phospholipids, and protein content in bronchoalveolar lavage fluids were assessed and clinical data prospectively recorded. Pulmonary function testing was performed 4 weeks after lung transplantation. Additionally, the best forced expiratory volume in 1 second was determined within the first year after lung transplantation. The control group consisted of 14 patients receiving donor lungs without surfactant instillation in randomized order. Pulmonary function test results were further compared with those of 154 consecutive recipients of bilateral lung transplants, which were not involved in the study (historical control).Results: No deaths occurred during the first year after lung transplantation. Surfactant function in donor lungs was within normal ranges before harvest. In the control group, surfactant function was markedly impaired after reperfusion. This was significantly improved by surfactant substitution. Protein content of the bronchoalveolar lavage fluid in the surfactant group was significantly lower, indicating less leakage through the alveolocapillary membrane. Forced expiratory volume in l second after 4 weeks was significantly higher in the surfactant group than in either control group (P =.034 and.01, respectively). Interestingly, the best forced expiratory volume in 1 second during the first year after lung transplantation was significantly higher in both control groups compared with forced expiratory volume measured in examinations 4 weeks after lung transplantation (P =.01). The best forced expiratory volumes in 1 second of control patients were comparable with those in surfactant lungs 4 weeks after transplant.Conclusions: This study indicates a protective effect of exogenous surfactant instillation to donor lungs before retrieval on post-lung transplantation surfactant function and on early clinical outcome. This approach may help to improve the outcome after lung transplantation in the future.