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Ann Thorac Surg 1996;62:302-314
© 1996 The Society of Thoracic Surgeons


Current Review

Lung Preservation: The Importance of Endothelial and Alveolar Type II Cell Integrity

Richard J. Novick, MD, Kenneth E. Gehman, MD, Imtiaz S. Ali, MD, John Lee, MD

Transplantation-Immunobiology Group, Robarts Research Institute, and Division of Cardiovascular-Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada

The practice of lung transplantation is constrained by a shortage of suitable donor organs. Furthermore, even "optimal" donor lung grafts are at risk of significant dysfunction perioperatively. Significant insights into the cellular and molecular mechanisms of pulmonary ischemia-reperfusion injury have occurred since the publication of previous reviews on lung preservation 3 to 4 years ago. Recent evidence indicates that the endothelium plays an essential role in regulating the dynamic interaction between pulmonary vasodilatation and vasoconstriction and is a major target during lung injury. In addition, the composition, function, and metabolism of pulmonary surfactant produced by alveolar type II cells are increasingly being recognized as important factors in pulmonary ischemia-reperfusion injury. We hypothesize that reperfusion after a period of pulmonary ischemia results in significant endothelial and alveolar type II cell dysfunction and that an important strategy in lung preservation is to preserve the integrity of these cells in the face of this injury. Given the persistent shortage of lungs available for transplantation, laboratory studies need to focus also on the "rescue" of compromised donor lungs that would have been previously regarded as unsuitable. Importantly, innovative work from the laboratory needs to be translated into clinical practice via prospective, randomized trials to ensure that the prevalence of postoperative lung graft dysfunction is reduced and the shortage of lung grafts for transplantation is alleviated.




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Wound-induced calcium waves in alveolar type II cells
Am J Physiol Lung Cell Mol Physiol, December 1, 1997; 273(6): L1242 - L1248.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
R. C. King, O. A. R. Binns, R. C. Kanithanon, P. E. Parrino, T. B. Reece, J. D. Maliszewskyj, K. S. Shockey, C. G. Tribble, and I. L. Kron
Acellular Low-Potassium Dextran Preserves Pulmonary Function After 48 Hours of Ischemia
Ann. Thorac. Surg., September 1, 1997; 64(3): 795 - 800.
[Abstract] [Full Text]


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Ann. Thorac. Surg.Home page
D. E. M. Van Raemdonck, N. C. P. Jannis, F. R. L. Rega, P. R. J. De Leyn, W. J. Flameng, and T. E. Lerut
Extended Preservation of Ischemic Pulmonary Graft by Postmortem Alveolar Expansion
Ann. Thorac. Surg., September 1, 1997; 64(3): 801 - 808.
[Abstract] [Full Text]


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Ann. Thorac. Surg.Home page
B. Hausen, P. Mueller, M. Bahra, R. Ramsamooj, R. E. Morris, and C. W. Hewitt
Donor Treatment With the Lazeroid U74389G Reduces Ischemia-Reperfusion Injury in a Rat Lung Transplant Model
Ann. Thorac. Surg., September 1, 1997; 64(3): 814 - 820.
[Abstract] [Full Text]


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J. Thorac. Cardiovasc. Surg.Home page
A. Watanabe, N. Kawaharada, K. Kusajima, S. Komatsu, T. Abe, and H. Takahashi
INFLUENCE OF OXYGEN IN INFLATION GAS DURING LUNG ISCHEMIA ON ISCHEMIA-REPERFUSION INJURY
J. Thorac. Cardiovasc. Surg., September 1, 1997; 114(3): 332 - 338.
[Abstract] [Full Text]


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J. Thorac. Cardiovasc. Surg.Home page
B. Hausen, R. Rohde, C. W. Hewitt, F. Schroeder, M. Beuke, R. Ramsamooj, H.-J. Schafers, Sponsor:, and H.-G. Borst
EXOGENOUS SURFACTANT TREATMENT BEFORE AND AFTER SIXTEEN HOURS OF ISCHEMIA IN EXPERIMENTAL LUNG TRANSPLANTATION
J. Thorac. Cardiovasc. Surg., June 1, 1997; 113(6): 1050 - 1058.
[Abstract] [Full Text]


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J. Thorac. Cardiovasc. Surg.Home page
S. Murakami, E. A. Bacha, P. Herve, H. Detruit, A. R. Chapelier, P. G. Dartevelle, G.-M. Mazmanian, and The Paris-Sud University Lung Transplantation Grou
INHALED NITRIC OXIDE AND PENTOXIFYLLINE IN RAT LUNG TRANSPLANTATION FROM NON-HEART-BEATING DONORS
J. Thorac. Cardiovasc. Surg., May 1, 1997; 113(5): 821 - 829.
[Abstract] [Full Text]


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Ann. Thorac. Surg.Home page
R. C. King, O. A. R. Binns, R. C. Kanithanon, J. T. Cope, R. L. Chun, K. S. Shockey, C. G. Tribble, and I. L. Kron
Low-Dose Sodium Nitroprusside Reduces Pulmonary Reperfusion Injury
Ann. Thorac. Surg., May 1, 1997; 63(5): 1398 - 1404.
[Abstract] [Full Text]


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J. Thorac. Cardiovasc. Surg.Home page
R. J. Novick, A. A. Gilpin, K. E. Gehman, I. S. Ali, R. A. W. Veldhuizen, J. Duplan, L. Denning, F. Possmayer, D. Bjarneson, and J. F. Lewis
MITIGATION OF INJURY IN CANINE LUNG GRAFTS BY EXOGENOUS SURFACTANT THERAPY
J. Thorac. Cardiovasc. Surg., February 1, 1997; 113(2): 342 - 353.
[Abstract] [Full Text]


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J. Thorac. Cardiovasc. Surg.Home page
R. J. Novick, L. Stitt, H.-J. Schafers, B. Andreassian, J.-P. Duchatelle, W. Klepetko, R. L. Hardesty, A. Frost, and G. A. Patterson
PULMONARY RETRANSPLANTATION: DOES THE INDICATION FOR OPERATION INFLUENCE POSTOPERATIVE LUNG FUNCTION?
J. Thorac. Cardiovasc. Surg., December 1, 1996; 112(6): 1504 - 1514.
[Abstract] [Full Text]




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