INCREASE OF C-REACTIVE PROTEIN AND DECREASE OF SURFACTANT PROTEIN-A IN SURFACTANT AFTER LUNG TRANSPLANTATION

In this study, we asked whether the serum acute-phase protein C-reacti ve protein (CRP) increased in large surfactant aggregates after lung t ransplantation and analyzed the changes in composition and interfacial adsorption activity of those aggregates. Single left lung transplanta tion was performed in weight-matched pairs of dogs. A double-lung bloc k from the donor animal was flushed with either modified Euro-Collins solution (EC) (n = 6) or University of Wisconsin solution (UW) (n = 6) at 4 degrees C followed by immersion in cold EC or UW for 22 h. The l eft donor lung was transplanted. The recipient dog was then reperfused for 4.5 h. Irrespective of the preservation fluid, gas exchanged was impaired in the transplanted lung after 4.5 h of reperfusion. Large su rfactant aggregates obtained from this lung showed reduced ability to rapidly adsorb to an air-liquid interface. Phospholipid (PL) content a nd FL composition of surfactant from lung transplants was similar to t hat of the control lungs. However, the content of surfactant protein A decreased after reperfusion. In addition, Western blot analyses showe d that levels of CRP increased in surfactant from transplanted but not from donor lungs. The addition of human CRP to control surfactant (CR P:PL weight ratio, 0.01:1) caused a decrease of surfactant adsorption. We conclude that the impairment of adsorption facilities of surfactan t from transplanted lungs may be correlated with decreased levels of s urfactant protein A and increased levels of CRP. The presence of eleva ted levels of CRP in bronchoalveolar ravage could be a very sensitive marker of lung injury.