Chest
Original ResearchCritical Care MedicineElevated Levels of the Receptor for Advanced Glycation End Products, a Marker of Alveolar Epithelial Type I Cell Injury, Predict Impaired Alveolar Fluid Clearance in Isolated Perfused Human Lungs
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Ex Vivo Human Lung Preparation
Lungs from brain-dead organ donors used for this study were rejected for transplantation by the Northern California Transplant Donor Network according to international criteria for human lung donors.10 The demographic data and the reasons for rejections were collected and analyzed. The lungs were prepared as previously described.9 Briefly, after consent from family was obtained, lungs from donors were removed en bloc, inflated, and transported on ice to the laboratory. The lungs were not
Demographic Data and Procurement Times
The demographic data and procurement times for the 30 lungs used in this study are summarized in Table 1. All patients died from catastrophic CNS events, including intracranial hemorrhage and anoxic brain injury. Lungs were rejected for transplantation for a variety of reasons, most commonly due to concern for suspicion of pulmonary edema, infection, or airway inflammation. The mean rewarming time (4° to 36°C) with perfusion was 53 ± 2 min.
AFC Rates, Hemodynamic Data, and Gas Tensions
Consistent with our previous studies, the mean AFC rate
Discussion
Clinical criteria used to evaluate donor lungs prior to transplantation may not be adequate as many lungs rejected for transplant appear to have normal alveolar epithelial function.1 Biological markers of lung endothelial and alveolar epithelial injury may have clinical value in determining the severity of alveolar barrier injury in potential transplant donor lungs or in patients with ALI. Prior studies have shown a relationship between elevated levels of vWF:Ag and poor clinical outcomes in
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Cited by (0)
This study was supported by National Heart, Lung, and Blood Institute HL51856 and HL088263 (Dr. Matthay), HL88440 (Dr. Frank), and Egide-Programme Lavoisier (Ministère Français des Affaires Etrangères) [Dr. Briot]. Dr. Calfee is supported by a National Heart, Lung, and Blood Institute K23 award (HL090833).
The authors have no conflicts of interest to disclose.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).