DONOR PRETREATMENT WITH AMBROXOL OR DEXAMETHASONE FAILS TO AMELIORATEREPERFUSION INJURY IN EXPERIMENTAL LUNG TRANSPLANTATION

Based on the known properties of ambroxol and dexamethasone to inhibit inflammation and increase endogenous surfactant levels. the potential advantage of donor pretreatment with either drug was investigated in an acute rat double-lung transplant model. Donor animals were randomly assigned to one of three treatment groups: an ambroxol group (AMB; 0. 4 mg/kg), a dexamethasone group (DX; 2 mg/kg); or an untreated control group (CN). Drugs were given intraperitoneally 6 h prior to harvest. Following standard preservation and 16 h of cold ischemia, the donor d ouble lung block was implanted into syngeneic recipients using custom- designed stents for the vascular anastomosis. During reperfusion, seri al measurements of graft pulmonary vascular resistance and alveolar-ar terial oxygen difference were obtained. Separate graft ventilation all owed determination of graft dynamic lung compliance. Final assessment included weight gain and histology. For phospholipid analysis, lung la vages were performed in the three study groups at the end of reperfusi on and compared to levels before graft harvest. Donor pretreatment did not significantly affect preharvest phospholipid levels. Survival fol lowing graft ischemia and reperfusion was shortest after AMB (92 +/- 5 min) and longest after DX (110 +/- 5 min; DX vs AMB P < 0.03) and CN (116 +/- 4 min; CN vs AMB P < 0.02). DX pretreatment provided better c ompliance (P < 0.02) and lower vascular resistance (P < 0.0001) than A MB treatment. Airway resistance was lower in the AMB and DX groups tha n in controls (P < 0.03 and P < 0.02, respectively). The alveolar-arte rial oxygen difference was markedly similar in all groups. Graft weigh t gain amounted to 114 % +/- 10 % in AMB, 88 % +/- 12 % in DX, and 98 % +/- 13 % in CN (P = NS). Thus, in this rat lung transplantation mode l, donor pretreatment with dexamethasone did not improve graft functio n compared to untreated controls and donor pretreatment with ambroxol was found to be potentially detrimental to graft function during reper fusion.