Wittwer Thorsten, Franke Ulrich, Fehrenbach Antonia, Meyer Daniel, Sandhaus Tim, Pfeifer Felix, Dreyer Niels, Mueller Thomas, Schubert Harald, Richter Joachim, Wahlers Thorsten
Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller University, 07740 Jena, Germany.
J Surg Res. 2004 Apr;117(2):239-48. doi: 10.1016/j.jss.2003.10.007.
Optimal preservation of postischemic organ function is a continuing challenge in clinical lung transplantation. Retrograde instillation of preservation solutions has theoretical advantages to achieve a homogeneous distribution in the lung due to perfusion of both the pulmonary and the bronchial circulation. Thus far, no systematic screening studies followed by in vivo large animal reevaluation including stereological analysis of intrapulmonary edema exist concerning the influence of retrograde preservation on postischemic lung function after preservation with low potassium dextran (LPD) solution (Perfadex).
For initial screening in an extracorporeal rat model eight lungs, each, were preserved for 4 h using antegrade or retrograde preservation with LPD solution (Perfadex; PER(ant)/PER(ret)). Respiratory and hemodynamic results after reperfusion were compared to low-potassium Euro-Collins (LPEC). For systematic reevaluation, five pig lungs, each, were preserved correspondingly for 27 h, and results were compared to sham-operated control lungs. In both models, edema formation was quantified stereologically. Statistics comprised different ANOVA models.
In both models, use of PER(ret) resulted in significantly higher oxygenation capacity, lower inspiratory pressures, and lower amounts of intraalveolar edema as compared to PER(ant). Results of PER(ret) were not different from sham controls in the in vivo model; furthermore, a continuous retrograde elimination of blood clots from pulmonary microcirculation was noticed.
Retrograde application of LPD solution (Perfadex) results in significant functional and histological improvement as compared to antegrade perfusion. This innovative technique can be applied very easily in clinical practice and might be an ideal adjunct to further optimize the results after lung transplantation with LPD-based graft protection.
在临床肺移植中，如何最佳地保存缺血后器官功能仍是一项持续面临的挑战。由于肺循环和支气管循环均能灌注，逆行灌注保存液在实现肺内均匀分布方面具有理论优势。迄今为止，尚无关于低钾右旋糖酐（LPD）溶液（Perfadex）保存后逆行保存对缺血后肺功能影响的系统性筛选研究，随后也未进行包括肺内水肿体视学分析在内的体内大型动物再评估。
在体外大鼠模型中进行初步筛选，每组8个肺分别采用顺行或逆行LPD溶液（Perfadex；PER(ant)/PER(ret)）保存4小时。将再灌注后的呼吸和血流动力学结果与低钾欧洲柯林斯液（LPEC）进行比较。为进行系统性再评估，每组5个猪肺分别采用相应方法保存27小时，并将结果与假手术对照肺进行比较。在两个模型中，均采用体视学方法对水肿形成进行定量分析。统计学分析采用不同的方差分析模型。
在两个模型中，与PER(ant)相比，使用PER(ret)均能显著提高氧合能力、降低吸气压力并减少肺泡内水肿量。在体内模型中，PER(ret)的结果与假手术对照组无异；此外，还观察到肺微循环中的血凝块能持续逆行清除。
与顺行灌注相比，逆行应用LPD溶液（Perfadex）可显著改善功能和组织学表现。这种创新技术在临床实践中易于应用，可能是基于LPD的移植物保护肺移植术后进一步优化结果理想辅助手段。
