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Ann Thorac Surg 2007;84:240-246
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

N-Acetylcysteine Attenuates Lung Ischemia–Reperfusion Injury After Lung Transplantation

^a Division of Thoracic Surgery, University of Zurich, Zurich, Switzerland
^b Department of Pathology, University of Zurich, Zurich, Switzerland

Accepted for publication March 26, 2007.

^_* Address correspondence to Dr Weder, University Hospital, Division of Thoracic Surgery, Rämistrasse 100, Zurich, 8091, Switzerland (Email: walter.weder{at}usz.ch).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31 2007.

Background: Early acute graft dysfunction continues to be a problem after lung transplantation and results in significant postoperative morbidity and mortality. This study assessed the protective effect of N-acetylcysteine (NAC) on posttransplant lung ischemia–reperfusion injury.

Methods: Rat single-lung transplantation was performed in two experimental groups (n = 5) after 18 hours of cold (4°C) ischemia. Group I was the ischemic control (IC) group. In group II (NAC), donor and recipient animals were treated with an intraperitoneal injection of 150 mg/kg NAC 15 minutes before harvest, and recipient animals were treated again before reperfusion. After 2 hours of reperfusion, oxygenation was measured. Lung tissue was assessed for lipid peroxidation, neutrophil infiltration, and reduced glutathione level. Peak airway pressure was recorded throughout the reperfusion period.

Results: Rats treated with NAC showed significantly better oxygenation (184.5 ± 83.3 mm Hg versus 67.3 ± 16.4 mm Hg, p = 0.016) and reduced lipid peroxidation (7.34 ± 1.9 µmol/g versus 17.46 ± 10.6 µmol/g, p = 0.016). Lung tissue reduced glutathione levels were 6.8 ± 0.9 µM in the IC group and 20.6 ± 2.4 µM in the NAC group (p = 0.004). Peak airway pressure at the end of the reperfusion period was 14.4 ± 1.6 cm H₂O in the NAC group, and 19.2 ± 2.2 cm H₂O in the IC group (p = 0.008). Myeloperoxidase activity and the ratio of wet-to-dry weight did not differ between the groups.

Conclusions: In this model, exogenously administered NAC effectively protected the lungs from reperfusion injury after prolonged ischemia.

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