PURPOSE: Lung transplantation is the procedure of choice for several end stage lung diseases. In spite of the improvement in surgical techniques and immunosuppressant therapy, early post operative complications remain common, especially reperfusion edema (early graft dysfunction) and acute rejection. Considering that there are few studies assessing the inflammatory response in pleural space after lung transplant, we propose to evaluate inflammatory cytokines in pleural effusions from patients submitted to lung transplant.
METHODS: βThe study includes sixteen patients (age 17 to 61) submitted to bilateral or left lung transplantation, between August 2005 and March 2007. After 6, 24, 48, 72 and 96 hours from the transplant, 20 ml of left pleural fluid was collected and IL-1beta, IL6, IL8, VEGF and TGF-beta were quantified by ELISA. All samples were exudates by Light criteria.
RESULTS: ANOVA RM followed by Holm Sidak method was used. IL-8, IL6 and TGF-beta levels were significantly higher at 6 h when compared to 48, 72 and 96 h (p<0.05).VEGF levels were more elevated at 6 hours than in 48 h (p=0.026). For IL-1beta, no significant differences were observed between the periods evaluated (p=0.212).
CONCLUSION: We observed a peak of the cytokines IL8, IL6, VEGF and TGF-beta; in the first 6 hours after lung transplantation. This must be explained by the recent surgical injury and the lack of an aggressive immunosuppressant schema in this period. In our protocol, we start the calcineurin inhibitor (cyclosporine or tacrolimus), 24 hours after the transplantation. Although we do not observe significant differences in cytokines levels in the other time-periods evaluated, they remain elevated, suggesting a slow recovering of the inflammatory process.
CLINICAL IMPLICATIONS: The characterization of the pleural inflammation after lung transplantation is important for better understand the early clinical complications of this surgical procedure.
DISCLOSURE: Ricardo Teixeira, No Financial Disclosure Information; No Product/Research Disclosure Information