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1 Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2650; 2 Cardiovascular Research Institute, University of California, San Francisco, California 94143-0130; 3 Thoracic Surgery, Kanazawa Medical University, Kanazawa, Japan 920-02; 4 Department of Surgery and Cardiothoracic Transplantation 94143, and 5 Departments of Medicine and Anesthesia, University of California, San Francisco, California 94143-0624
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) 
-adrenergic stimulation. Terbutaline-stimulated clearance (10
4 M) 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
2-adrenergic agonist stimulates alveolar fluid clearance
in the human donor lung. Aerosolized 2-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.
pulmonary edema; -agonist; alveolar epithelial fluid
transport; alveolar epithelium; lung preservation
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