Serum tumor necrosis factor α, Interleukin-6, and polymorphonuculear elastase levels during lung transplantation with cardiopulmonary bypass

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We have succeeded a living-donor lober lung transplantation (LDLLT) at Okayama University Hospital in 1998, which was the first lung transplantation (LT) in Japan. The acute phase mortality rate of LT is higher than that of heart transplantation. Between October 1998 and February 2007, we performed LT in 55 critically ill patients with various lung diseases. 51 recipients are currently alive, with a follow-up period of 1 to 120 months. A major cause of the death is reperfusion lung injury (RLI) and the treatment has not been established. LT is generally performed with the use of cardiopulmonary bypass (CPB) in Japan. RLI occurs following lung transplantation, and is a major perioperative complication. CPB exacerbates inflammatory response in recipient and reperfusion of grafts after CPB may deteriorate ischemia-reperfusion injury. Inflammatory mediators play an important role in the modulation of reperfusion injury. The purpose of this study is to measure intraoperative levels of key c … More ytokines and polymorphonuclear elastase (PMN-E) in plasma in patients undergoing LDLLT surgery with CPB. Anesthesia was induced with fentanyl 50-100μg/kg and pancuronium. Arterial blood sample were collected at 3 time points, before CPB, during CPB (30 minutes before reperfusion), and 2 hour after CPB (after LT procedure). CPB was performed with nonpulsatile flow under moderate hypothermia, using a microporous membrane oxygenator and bovine heparin anticoagulation. Patients were treated with methylprednisolone (30 mg/kg) IV during CPB just before reperfusion of donor lobes. Tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and PMN-E concentrations were measured by CLEIA and latex agglutination method (MBC, Tokyo, Japan). LT patients demonstrated significant elevations of IL-6 and PMN-E during and after CPB. IL-6 production increased significantly after CPB. Ischemic and CPB time did not correlate with IL-6 and PMN-E levels. Our data suggest that production of inflammatory cytokines and mediators are triggered by CPB and that production of IL-6 is accelerated by reperfusion of lung grafts after CPB. In order to prevent ischemia-reperfusion lung injury, it may be beneficial to reduce IL-6 levels when. LDLLT surgery with CPB is performed. Less