Invited Commentary

Abstract

Listen

Translate article

Lung transplantation is a well-established life-saving procedure for patients with end-stage lung diseases. However, the number of patients waiting for a lung transplant greatly exceeds the number of available donors. On average, only 15% of lungs from multiorgan donors are used for transplantation; the remaining lungs are considered unsuitable owing to the lung injury that occurs after brain death and to complications associated with treatment in the emergency department or the intensive care unit, including barotrauma, pulmonary edema, and aspiration. The experimental work by Inci and colleagues [1Steen S. Sjoberg T. Pierre L. Liao Q. Eriksson L. Algotsson L. Transplantation of lungs from a non-heart-beating donor.Lancet. 2001; 357: 825-829Abstract Full Text Full Text PDF PubMed Scopus (512) Google Scholar] in a porcine transplantation model evaluates diluted surfactant lavage as a potential intervention for donor lungs that have been damaged by gastric content aspiration before transplantation. Unfortunately, the study design did not include a second control group with bronchoalveolar lavage alone, and therefore, the contribution of bronchoalveolar lavage to the functional improvement could not be identified. Nevertheless, the authors clearly demonstrate that the bronchoscopic application of diluted surfactant before reperfusion can effectively improve the graft function of donor lungs injured by gastric acid aspiration. Normothermic ex vivo lung perfusion, as pioneered by Steen and colleagues [2Inci I. Hillinger S. Arni S. et al.Surfactant improves graft function after gastric acid-induced lung damage in lung transplantation.Ann Thorac Surg. 2013; 95: 1013-1020Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar], has evolved in some centers into a standard platform to evaluate and repair donor lungs. Although pulmonary edema can now be easily reversed during ex vivo lung perfusion, repair of injuries induced by aspiration or infection remains a clinical challenge. The work by Inci and colleagues is a great example of the reconditioning of donor lungs in a way necessary to meet two obligatory goals: (1) extending the possible donor pool while (2) ascertaining optimal posttransplant outcomes. It raises hope that combining the technique presented with other available technologies, such as ex vivo lung perfusion, will substantially increase the number of donor lungs that can be considered suitable for lung transplantation. Surfactant Improves Graft Function After Gastric Acid–Induced Lung Damage in Lung TransplantationThe Annals of Thoracic SurgeryVol. 95Issue 3PreviewThe number of available donor lungs is still the limiting factor in lung transplantation. We have recently shown that diluted surfactant lavage during ex vivo lung evaluation improved the graft function after gastric acid aspiration. In the present study, we hypothesized that diluted surfactant administration would recondition and improve the graft function after acid aspiration–induced lung injury in a porcine model of pulmonary transplantation. Full-Text PDF