Prevention of primary graft dysfunction in lung transplantation by N-acetylcysteine after prolonged cold ischemia

BACKGROUND: N-Acetylcysteine (NAC), a thiol-containing compound that has been used as an anti-oxidant, may also lead to an increased glutathione synthesis. This study assessed the protective effect of NAG on primary graft dysfunction after lung transplantation. METHODS: Porcine single left-lung transplantation was performed in 2 experimental groups after 24 hours of cold storage. Donor and recipient animals were treated with intravenous injection of 150 mg/kg NAC 60 minutes before harvest and reperfusion, followed by 12.5 mg/kg/hour continuous perfusion during the 8-hour observation period (NAG). Control animals did not receive any treatment. Hemodynamic and respiratory parameters were recorded throughout the observation period. Bronchoalveolar lavage (BAL) nitrite, neutrophil elastase (NE), protein accumulation, interleukin (IL)-8, nuclear factor-kappa B (p50 sub-unit), and reduced glutathione (GSH) in lung tissue and red blood were measured. RESULTS: During the observation period, the mean pulmonary artery pressure, oxygenation, airway pressure, and static lung compliance were significantly better in NAG animals compared with controls (p < 0.05). Extravascular lung water index was higher at points during the reperfusion in the control group. BAL protein, nitrite, NE, and IL-8 cytokine levels at the end of the experiment were significantly higher in the controls than in the NAG group (p < 0.05). Lung tissue reduced GSH levels were significantly higher in the NAG group than in the control group. Red blood cell GSH levels were always higher in the NAG group during the reperfusion period. Reverse transcription polymerase chain reaction for IL-8 messenger RNA was significantly higher in controls during the reperfusion period than in the NAG group (p = 0.001). The amount of lung tissue nuclear NF-kappa B (p50 sub-unit) was significantly higher in controls than in NAG pigs (p = 0.03). CONCLUSION: In this model, donor and recipient treatment with NAG effectively protected the lung from primary graft dysfunction after prolonged cold ischemia. J Heart Lung Transplant 2010;29: 1293-301 (C) 2010 International Society for Heart and Lung Transplantation. All rights reserved.