Aj. Boujoukos et al., REPERFUSION INJURY IN SINGLE-LUNG TRANSPLANT RECIPIENTS WITH PULMONARY-HYPERTENSION AND EMPHYSEMA, The Journal of heart and lung transplantation, 16(4), 1997, pp. 439-448
Citations number
14
Categorie Soggetti
Cardiac & Cardiovascular System",Transplantation,"Respiratory System
Background: The early postoperative course of single-lung transplant r
ecipients depends on the recipient's underlying lung pathophysiology a
nd the degree of ischemic-reperfusion injury. We examined the effect o
f pulmonary hemodynamics and preoperative diagnosis on early allograft
function and the effects of pulmonary hemodynamics, allograft blood f
low, and chest radiographs on length of mechanical ventilation and int
ensive care unit length of stay. Methods: We retrospectively collected
data on 30 single-lung transplant recipients, 15 each with pretranspl
antation pulmonary hypertension and emphysema. Blood flow to the allog
rafts was quantitated by perfusion scans obtained on the first postope
rative day. Chest radiographs were graded for reperfusion injury. Pulm
onary and hemodynamic data, gas exchange parameters, duration of mecha
nical ventilation, and intensive care unit stay were recorded. Results
: Patients with pulmonary hypertension had a prolonged intensive care
unit stay compared with emphysema patients, but pulmonary artery press
ures were not quantitatively related to duration of ventilation during
the intensive care unit stay. There was no difference in the severity
of allograft infiltrate between the emphysema and pulmonary hypertens
ive patients. The day 1 chest radiograph score was highly predictive o
f an intensive care unit stay of greater than or equal to 7 days, alth
ough the threshold score of those with pulmonary hypertension was sign
ificantly lower than in emphysema patients. Allograft blood flow and p
ulmonary hypertension were not contributors to early graft dysfunction
. Allograft perfusion decreased with increasing radiographically demon
strated infiltrate in those with emphysema but not in those with pulmo
nary hypertension. Conclusions: Elevated allograft blood flow and pres
sures do not exacerbate radiographically confirmed reperfusion injury.
Reperfusion injury is the major cause of early respiratory morbidity
after single-lung transplantation. Allograft perfusion in emphysema pa
tients decreases in response to reperfusion injury, but pulmonary hype
rtension patients remain almost entirely dependent on allograft functi
on, even with severe chest radiograph scores. This may be an important
mechanism by which single-lung transplant recipients with emphysema,
unlike those with pulmonary hypertension, are able to mitigate the deg
ree of respiratory impairment associated with reperfusion injury.