[Assessment of ischemia-reperfusion injury and early acute rejection in experimental lung transplantation after prolonged ischemia]

Effect of Intravenous Lidocaine on Inflammatory and Apoptotic Response of Ischemia-Reperfusion Injury in Pigs Undergoing Lung Resection Surgery

Background

Ischemia-reperfusion injury is one of the most critical phenomena in lung transplantation and causes primary graft failure. Its pathophysiology remains incompletely understood, although the inflammatory response and apoptosis play key roles. Lidocaine has anti-inflammatory properties. The aim of this research is to evaluate the effect of intravenous lidocaine on the inflammatory and apoptotic responses in lung ischemia-reperfusion injury.

Methods

We studied the histological and immunohistochemical changes in an experimental model of lung transplantation in pigs. Twelve pigs underwent left pneumonectomy, cranial lobectomy, caudal lobe reimplantation, and 60 minutes of graft reperfusion. Six of the pigs made up the control group, while six other pigs received 1.5 mg/kg of intravenous lidocaine after induction and a 1.5 mg/kg/h intravenous lidocaine infusion during surgery. In addition, six more pigs underwent simulated surgery. Lung biopsies were collected from the left caudal lobe 60 minutes after reperfusion. We conducted a double study on these biopsies and assessed the degree of inflammation, predominant cell type (monocyte-macrophage, lymphocytes, or polymorphous), the degree of congestion, and tissue edema by hematoxylin and eosin stain. We also conducted an immunohistochemical analysis with antibodies against CD68 antigens, monocyte chemoattractant protein-1 (MCP-1), Bcl-2, and caspase-9.

Results

The lungs subjected to ischemia-reperfusion injury exhibited a higher degree of inflammatory infiltration. The predominant cell type was monocyte-macrophage cells. Both findings were mitigated by intravenous lidocaine administration. Immunohistochemical detection of anti-CD68 and anti-MCP-1 showed higher infiltration in the lungs subjected to ischemia-reperfusion injury, while intravenous lidocaine decreased the expression. Ischemia-reperfusion induced apoptotic changes and decreased Bcl-2 expression. The group treated with lidocaine showed an increased number of Bcl-2-positive cells. No differences were observed in caspase-9 expression.

Conclusions

In our animal model, intravenous lidocaine was associated with an attenuation of the histological markers of lung damage in the early stages of reperfusion.

Prolonged cold ischemic time results in increased acute rejection in a rat allotransplantation model

BACKGROUND

The cold ischemic time may be more prolonged for facial tissue allografts than for organ allografts. Previous researches have shown that prolonged ischemia resulted in increased signs of rejection in a rat groin allotransplantation model; however, the relationship between cold ischemia and alloantigen-induced rejection was unclear.

MATERIALS AND METHODS

Vascularized groin flaps were transplanted from BN to Lewis rats after 0, 6, 12, 18, or 24 h of storage at 4 °C, and the allografts in each group were evaluated daily. Biopsy samples taken from the allo-0 h and allo-24 h groups on postoperative d 2-8 were graded for signs of acute rejection. Biopsy samples taken from the allo-0 h and allo-24 h groups on postoperative d 5 were stained for chemokine receptor CXCR3.

RESULTS

When the cold ischemia time was greater than 18 h, the survival time of the grafts was significantly shorter (6.2 ± 1.3 d) than that of the grafts that did not undergo cold ischemia (9.0 ± 1.2 d). Histological valuation showed acceleration of activated lymphocyte infiltration in the allo-24 h group (2.2 ± 0.4 d) compared with the allo-0 h group (4.8 ± 0.4 d). Furthermore, the proportion of CXCR3-positive cells in the allo-24 h group (49.7% ± 6.0%) was significantly higher than that in the allo-0 h group (22.9% ± 3.4%) on d 5 after transplantation.

CONCLUSIONS

Prolonged ischemia has a deleterious effect on allograft survival, and the chemokine receptor CXCR3 may play a role in this process.