Influence of Donor Lung Surfactant-A and -B Protein Expression on the Development of Primary Graft Dysfunction After Lung Transplantation: A Pilot Study

Abstract

BACKGROUND Primary graft dysfunction (PGD) is responsible of high early mortality in lung transplanted patients. We measured the rate of surfactant proteins in the organ donor, and we observed the occurrence of lung PGD in the recipient. The co-relation between these two parameters was evaluated. MATERIAL AND METHODS In this pilot study, we prospectively collected blood samples and lung biopsies in thirteen donors at the time of recovery of organs before preservation. Gene expression of SP-A, SP-B, SP-D, and CC16 was evaluated by real-time quantitative PCR. Surfactant proteins plasma levels were evaluated by ELISA. Post-transplant assessments included hemodynamic, arterial blood gas measurements, and radiographic evaluation to determine PGD and lung biopsies. RESULTS Nine of the thirteen recipients (69%) developed lung infiltrates and four (31%) developed PGD at either stages 2 or 3. SP-A and SP-B expressions were dramatically reduced in lung allografts of these patients, while lung expression of SP-D and CC16 remained unchanged. Plasma levels of SP-A, SP-B, SP-D, and CC16 did not differ. CONCLUSIONS Primary graft dysfunction may be initiated in the donor. Lung allografts with low lung SP-A and SP-B gene expression prior to implantation are associated with increased incidence of lung infiltrates after transplantation.

Figure 1

Relative RNA content in lung tissue measured by RTQ-PCR for surfactant proteins SP-A, SP-B, SP-D and CC16 (Clara cell secretory protein (16-kd Clara cell protein) in donors. Comparisons between PGD(−) and PGD(+) groups. The values are expressed as a mean ±SEM (standard error of the mean).

Figure 2

Serum dosage measured by ELISA for surfactant proteins SP-A, SP-B, SP-D, and CC16 (Clara cell secretory protein (16-kd Clara cell protein) in donors. Comparisons between PGD(−) and PGD(+) groups. The values are expressed as a mean ±SEM (standard error of the mean).