Role of brain stem death (BSD) in subsequent organ dysfunction. We wished to examine the effect of BSD on the endothelin (ET) axis. Methods Following ethics approval, 14 Wistar yoto rats were anaesthetised, with tracheostomy and arterial and venous cannulation. A 200 Fogarty’s CA-074 methyl ester balloon catheter was inserted via a burr hole into the subdural vault. The balloon was inflated in the experimental group but not the control group. Four hours of positive pressure ventilation were followed by euthanasia and organ retrieval. Lung tissue was stained for H E for morphology, and alveolar macrophages (AM) were identified by anti-CD68 staining. AM were stained with a monoclonal anti-ET-1 antibody, as well as the polyclonal anti-ET-A and ET-B. Results All animals survived the experiment. There was a significant increase in the ratio of AM to neutrophils (P = 0.002). The ET-1 content on the AM was significantly increased in PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20800871 the experimental group (27.57 ?5.26 vs 7.01 ?1.75, P < 0.0001). Conclusions In this model, BSD was associated with an increase in the ratio of AM to neutrophils, and there was significant upregulation of the endothelin axis on these AM, as evidenced by raised levels of ET-1, ET-A and ET-B. There may be a role for endothelin blockade in the BSD organ donor. This may increase the yield of organs that can be accepted for transplantation and improve early graft function in the recipient.P474 Prognosis factors in lung transplant recipients readmitted to the intensive care unitB Suberviola, A Gonzalez Castro, J Llorca, A Vallejo, C Gonzalez Mansilla, E Mi mbres Hospital Universitario Marques de Valdecilla, Santander, Spain Critical Care 2007, 11(Suppl 2):P474 (doi: 10.1186/cc5634) Introduction The short-term survival after lung transplantation has improved gradually. Despite this the peritransplant period is of high risk. Factors influencing the readmission of lung transplant recipients to the ICU are diverse, but respiratory failure and sepsis are the predominant causes. The objective of our study was to identify outcome predictors and prognostic factors for survival among lung transplant recipients on readmission to the ICU. Materials and methods A retrospective study of all lung transplant recipients achieved during a 10-year period (from 1997 to 2006). Data collection included the age, gender, reason for and type of lung transplantation. Variables specific to individual ICU admissions included the admission diagnosis, length of stay, duration of mechanical ventilation, interval time from transplantation, Acute Physiology and Chronic Health Evaluation (APACHE) II score on ICU admission, and the identification of systemic organ dysfunction. We used Student's t test (or, where appropriate, its nonparametric equivalent) or the 2 test for comparisons among the patients who died and the patients who survived their ICU admissions. Results A total of 144 lung transplants were performed at our institution. Forty-six of them died on the ICU during the immediate perioperative period. Finally, 98 were discharged from the ICU. Twenty-eight patients were readmitted to the ICU after discharge (28.57 ). The mean of age was 51.3 ?11.6 years. The male/female ratio was 23/5. The mean period transcurred between ICU discharge and ICU readmission was 107 ?162 days. The admission diagnosis was sepsis in 20 cases (71.4 ). Seventeen patients died during the ICU stay (60.7 ). We found that anP473 Upregulation of the endothelin axis in alveolar macrophages fol.