Surfactant replacement in reperfusion injury after clinical lung transplantation

Background: Reperfusion injury remains a significant risk factor in the imm ediate postoperative course after lung transplantation. We report on our in itial clinical experience of surfactant replacement in reperfusion injury a fter clinical lung transplantation. Methods and results: In 31 consecutive patients, lung (8 single lung, 16 bi lateral lung) or heart-lung (7) transplantation was performed. In 6 patient s, severe reperfusion injury developed and was treated with continuously ne bulized surfactant. Compliance of the allograft increased 40 +/- 25 % withi n 3 h following treatment with surfactant. Alveolar arterial oxygen gradien t decreased by 23 +/- 11 % after 3 h and by 35 +/- 20 % after 6 h. Normal g raft function was reestablished within 1-3 days after transplantation. All treated recipients were extubated until the 6th postoperative day. The 30-d ay mortality for the 31 recipients was 3.3 %, the 1-year survival 84 %. Conclusions: Surfactant replacement may become a clinical method for treatm ent of reperfusion injury after lung transplantation.