Abstract
This review addresses surfactant alterations and treatment in lung transplant ischemia–reperfusion injury. Lung ischemia–reperfusion injury damages the endogenous surfactant system as a result of the production of reactive oxygen species, proteolytic enzymes and (phospho)lipases. Surfactant is composed of phospholipids and proteins and its main function is to reduce the surface tension inside the alveolus. Impairment of surfactant will cause atelectasis, influx of serum proteins, pulmonary edema, decreased lung compliance and impaired gas exchange. Surfactant therapy restores the quantity and composition of surfactant and reduces the inhibitory effect of serum proteins; other effects are that it serves as an antioxidant and anti-inflammatory agent. Pretreatment may be more beneficial than treatment after the development of lung ischemia–reperfusion injury. However, the cost of surfactant must be weighed against the clinical outcome.