Thorac Cardiovasc Surg 2006; 54 - PP_88
DOI: 10.1055/s-2006-925870

Intravenous versus inhalative administration of Iloprost for donor lung pretreatment – which route is superior in experimental pig lung transplantation?

T Wittwer 1, U Franke 1, T Sandhaus 1, M Thiene 1, T Wahlers 1
  • 1Friedrich-Schiller Universität Jena, Klinik für Herz-, Thorax- und Gefäßchirurgie, Jena, Germany

Aims: Lung transplantation is still limited by organ shortage. Therefore, optimal allograft protection is essential to reduce postoperative organ dysfunction. After intravenous prostanoids are routinely used to ameliorate reperfusion-injury, latest evidence suggests similar efficacy of inhaled prostacyclin. Therefore, we compared inhalative donor lung-pretreatment using Iloprost with the commonly used intravenous technique.

Methods: In group 1, five pig lungs, each, were preserved with Perfadex solution and stored for 27 hrs. In group 2, 100ìg of Iloprost were aerosolized over 30-min prior to organ harvest, while in group 3, 100ìg of Iloprost were administered i.v. Following left lung transplantation and contralateral lung exclusion, hemodynamics, pO2/FiO2 and compliance were monitored for 6-hrs and compared to sham-operated controls. Pulmonary edema was determined by W/D-ratio and stereological evaluation. Statistics comprised ANOVA analysis with repeated measures.

Results: While mortality was 100% in the intravenously treated Ilomedin group, all other animals survived (p<0.001). Dynamic compliance and PVR were superior in the endobronchially pretreated Ilomedin group as compared to untreated organs (p<0.05), while oxygenation was overall comparable. W/D-ratio revealed significantly lower lung water in endobronchially pretreated organs (p=0.027) as compared to the intravenous application group, while stereology did not reveal significantly different results.

Conclusion: Preischemic alveolar deposition of Iloprost in donor lungs ameliorates edema and significantly improves lung compliance and PVR and therefore offers an important strategy for improvement of pulmonary preservation. In contrast, in this in-vivo model intravenous application of the same dosis of Iloprost exclusively results in lethal recipient right heart failure due to significantly increased intrapulmonary edema.