Selected Contribution: Mechanisms that may stimulate the resolution of alveolar edema in the transplanted human lung

Abstract

Pulmonary edema is common in organ donors and lung transplant recipients. Therefore, we assessed the responsiveness of human donor lungs to pharmacological agents that stimulate clearance of alveolar edema. Organ donors whose lungs were rejected for transplantation were studied. After resection, transport (4°C), and rewarming (37°C) of lungs, alveolar fluid clearance was measured with ( n = 8 donors) or without ( n = 23 donors) β-adrenergic stimulation. Terbutaline-stimulated clearance (10−4M) was higher than unstimulated clearance (7.1 ± 1.3 vs. 4.8 ± 2.4%/h, P < 0.01). Second, we determined whether medications given to the organ donor were associated with the extent of pulmonary edema or the rate of alveolar fluid clearance in the harvested lung. Preharvest administration of dopamine in low to moderate doses was associated with faster alveolar fluid clearance ( r = 0.62, P < 0.01). Preharvest administration of diuretics was associated with lower extravascular lung water-to-dry weight ratios. This study provides the first evidence that a β2-adrenergic agonist stimulates alveolar fluid clearance in the human donor lung. Aerosolized β2-adrenergic agonists may have therapeutic value for hastening the resolution of alveolar edema during the management of donors before resection of lungs for transplantation or in the posttransplant setting.