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Related Experiment Video

Updated: May 15, 2026

A Rat Lung Transplantation Model of Warm Ischemia/Reperfusion Injury: Optimizations to Improve Outcomes
07:37

A Rat Lung Transplantation Model of Warm Ischemia/Reperfusion Injury: Optimizations to Improve Outcomes

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Surfactant application in experimental lung transplantation.

Thorsten Wittwer1, Navid Madershahian, Parwis Rahmanian

  • 1Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany. th.wittwer-md@t-online.de

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|January 15, 2013
PubMed
Summary

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Administering Curosurf surfactant before lung preservation optimizes organ quality in non-heart-beating donors (NHBDs). However, extended warm ischemia time (WIT) negates benefits, indicating a 7-hour WIT limit for NHBD lung transplantation.

Area of Science:

  • Pulmonary medicine
  • Transplantation surgery
  • Biomedical engineering

Background:

  • Non-heart-beating donor (NHBD) lung transplantation expands the donor pool but risks ischemia/reperfusion injury (IRI) and surfactant inactivation.
  • Exogenous surfactant (Curosurf) can prevent and treat IRI, but optimal timing for NHBD lung preservation is unstudied.
  • Investigating Curosurf timing could enhance NHBD lung transplant outcomes.

Purpose of the Study:

  • To determine the optimal timing for Curosurf administration in non-heart-beating donor (NHBD) lung preservation.
  • To evaluate the efficacy of pre-preservation Curosurf in mitigating ischemia/reperfusion injury (IRI) and improving lung function.
  • To assess the impact of extended warm ischemia time (WIT) on NHBD lung allograft viability.

Main Methods:

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Last Updated: May 15, 2026

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Published on: October 28, 2021

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  • Utilized an extracorporeal screening model (ESM) with rat lungs preserved in Perfadex, with Curosurf administered pre-flush (T1), post-4-hour ischemia (T2), or during reperfusion (T3).
  • Employed a transplantation model (TM) with asystolic pigs subjected to 7-hour warm ischemia (WIT), with Curosurf administered bronchoscopically pre-preservation in one group.
  • Compared functional outcomes, including oxygenation, edema, and vascular leakage in ESM, and survival rates in TM, against control groups.

Main Results:

  • Pre-preservation Curosurf (T1) in the ESM significantly improved lung oxygenation (167±47.4 mm Hg) compared to other groups (p<0.02).
  • Surfactant treatment markedly reduced intra-alveolar edema and erythrocyte sequestration, indicating less vascular leakage, particularly with pre-preservation application (p<0.02).
  • In the TM, 7-hour WIT resulted in high mortality (80% untreated, 100% Curosurf-treated), suggesting this WIT exceeds viability limits for NHBDs.

Conclusions:

  • Pre-preservation endobronchial Curosurf offers superior lung preservation quality and functional outcomes compared to post-ischemic or reperfusion application.
  • Curosurf administration cannot overcome the detrimental effects of extended WIT, making it unsuitable for NHBD lungs after prolonged ischemia.
  • A 7-hour WIT appears to be a critical threshold, generally exceeding the limits for successful NHBD lung transplantation.