Wittwer Th, Franke U F W, Fehrenbach Antonia, Sandhaus T, Pfeifer F, Dreyer N, Mueller Th, Schubert H, Petrow P, Richter J, Wahlers Th
Department of Cardiothoracic and Vascular Surgery, Friedrich Schiller University, Jena, Germany.
Eur Surg Res. 2004 Jan-Feb;36(1):1-7. doi: 10.1159/000075067.
Lung transplantation is limited by the scarcity of donor organs. Lung retrieval from non-heart-beating donors (NHBD) might extend the donor pool and has been reported recently. However, no studies in NHBD exist using the novel approach of retrograde preservation with Perfadex solution.
Heparinized asystolic pigs (n = 5, 30-35 kg) were ventilated for 90 min. The lungs were retrogradely preserved with Perfadex solution and stored inflated at 4 degrees C for 3 h. Left lung transplantation in the recipient was followed by exclusion of the right lung. Results were compared to sham-operated animals. Oxygenation, hemodynamics and dynamic compliance were monitored for 4 h. Infiltration of polymorphonuclear cells (PMNs) and stereological quantification of alveolar edema was performed. Statistical analysis comprised Kruskal-Wallis and Mann-Whitney tests and ANOVA analysis with repeated measures.
No mortality was observed. During preservation, continuous elimination of blood clots via the pulmonary artery venting site was observed. Oxygenation and compliance were similar between groups, but sham controls showed significantly lower pulmonary vascular resistance. Stereological quantification revealed higher volume fractions of intra-alveolar edema in NHBD grafts, while PMN infiltration was comparable to sham controls.
Use of NHBD lungs results in excellent outcome after 90 min of warm ischemia followed by retrograde preservation with Perfadex solution. This novel approach can optimize lung preservation by eliminating clots from the pulmonary circulation and might clinically be considered in brain-dead organ donors who become hemodynamically unstable prior to organ harvest. Further trials with longer warm and cold ischemic periods are necessary to further elucidate this promising approach to donor pool expansion.
肺移植受供体器官稀缺的限制。从非心脏跳动供体（NHBD）获取肺脏可能会扩大供体库，且近期已有相关报道。然而，目前尚无关于使用Perfadex溶液逆行保存这种新方法用于NHBD的研究。
对肝素化的停跳猪（n = 5，体重30 - 35千克）进行90分钟通气。用Perfadex溶液对肺脏进行逆行保存，并在4℃充气保存3小时。受体行左肺移植，右肺不予处理。将结果与假手术动物进行比较。监测氧合、血流动力学和动态顺应性4小时。进行多形核细胞（PMN）浸润和肺泡水肿的体视学定量分析。统计分析包括Kruskal - Wallis检验、Mann - Whitney检验以及重复测量的方差分析。
未观察到死亡情况。在保存过程中，观察到通过肺动脉排气部位持续清除血凝块。两组之间氧合和顺应性相似，但假手术对照组的肺血管阻力显著更低。体视学定量分析显示，NHBD移植物中肺泡内水肿的体积分数更高，而PMN浸润与假手术对照组相当。
使用NHBD肺脏，经90分钟热缺血后用Perfadex溶液逆行保存，可获得良好结果。这种新方法可通过清除肺循环中的血凝块来优化肺保存，对于在器官获取前血流动力学不稳定的脑死亡器官供体，临床上可予以考虑。有必要进行更长热缺血和冷缺血时间的进一步试验，以进一步阐明这种扩大供体库的有前景方法。
