Addition of a neutrophil elastase inhibitor to the organ flushing solution decreases lung reperfusion injury in rat lung transplantation

Background: Neutrophil elastase plays an important rote in ischemia-reperfusion injury. We hypothesized that the addition of sivelestat, a specific neutrophil elastase inhibitor, to the organ flushing solution would decrease reperfusion injury in a rat single left-lung transplant model. Methods: All donor lungs were flushed with 25 ml tow-potassium dextran-glucose solution and stored for 16 h at 4 degrees C. Rats were divided into three experimental groups (n = 10) that received donor lungs washed in either normal flushing solution (group 1), or flushing solution containing 20 mg sivelestat (group 2) or 40 mg sivelestat (group 3). Graft function was assessed 48 h after reperfusion using five measurements: isolated graft oxygenation, wet/dry ratio, peak airway pressure, tissue myeloperoxidase activity, and serum lipid peroxides level. Histological examination of lung grafts was also performed. Results: Group 3 showed better oxygenation (groups 1, 2, and 3: 133.9 +/- 113.5, 254.0 +/- 84.6, and 378.7 +/- 77.6 mmHg, respectively; p < 0.0001 vs group 1, p = 0.0052 vs group 2), lower peak airway pressure (groups 1, 2, and 3: 28.7 +/- 6.1, 26.0 +/- 5.8, and 21.5 +/- 5.3 mmHg, respectively; p = 0.0385 vs group 1), tower wet/dry ratio (groups 1, 2, and 3: 6.74 +/- 0.78, 5.77 +/- 0.52, and 4.90 +/- 0.16, respectively; p = 0.0010 vs group 1), and lower myeloperoxidase activity (groups 1, 2, and 3: 0.304 +/- 0.081, 0.178 +/- 0.053, and 0.106 +/- 0.029 Delta OD/mg/min, respectively; p < 0.0001 vs group 1, p = 0.0319 vs group 2). No significant differences in arterial PaCO2 and serum lipid peroxide levels were observed between the three groups. Conclusions: Addition of sivelestat to the organ flushing solution ameliorated ischemia-reperfusion injury in a lung transplant model. (C) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.