Modified low-flow ultrafiltration ameliorates hemodynamics and early graft function and reduces blood loss in living-donor lobar lung transplantation

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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. We performed LT in 57 critically ill patients (47 patients of LDLLT) from 1999 to 2007. Reperfusion lung injury (RLI) occurs following lung transplantation, and is a major post-operative complication. A major cause of the death is RLI and the treatment has not been established in LT. Inflammatory mediators play an important role in the modulation of reperfusion injury. LDLLT is generally performed with the use of cardiopulmonary bypass (CPB). CPB exacerbates inflammatory response in recipient and the reperfusion of grafts after CPB may deteriorate ischemia-reperfusion injury. Modified ultrafiltration (MUF) has been developed as an effective perfusion strategy to minimize the adverse effects of CPB in open heart surgery. MUF may modulate systemic inflammatory mediators and inprove hemoddynamics and graft function after LT. No … More report of the effectiveness of MUF in LT has shown. We measure intraoperative levels of key cytokines and polymorphonuclear elastase (PMN-E) in plasma in patients undergoing LDLLT surgery with CPB. This study analyzed the clinical application of MUF to minimize cardiopulmonary bypass (CPB)-related lung injury in patients undergoing LDLLT.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. MUF did not inhibit the increase of serum IL-6 level, nor decrease IL-8 and PMN-E levels. MUF brought improved hemodynamics and gas exchange capacity of transplanted grafts and lowered post-operative blood loss and blood transfusion requirement. This strategy may minimize CPB-related adverse effects in patients undergoing LDLLT. Less