Lang György, Vadász Pál, Czebe Krisztina, Oláh Csaba, Furák József, Papp András, Csekeo Attila, Klepetko Walter
Országos Korányi Tbc és Pulmonológiai Intézet, Budapest.
Magy Seb. 2004 Aug;57(4):195-200.
Hungarian patients undergo lung transplantation within bilateral cooperation in Vienna, Austria since 1995. Lung harvesting was introduced in 2002 in Hungary. Before 2002 Hungarian patients get 16 donor lungs from abroad, and 4 patients died while being on the waiting list for transplantation.
Between 15/1/2002 and 31/12/2003 Hungarotransplant offered 164 potential lung donors to the Korányi National Institute for Pulmonology. Donor selection was performed according to international guidelines. All operations were performed as part of multiorgan harvesting. Immediately before cross clamping the aorta 500 microg epoprostenol (Flolan) was administered intravenously for opening the pulmonary vascular bed. The lung was perfused through the main pulmonary trunk with a single flush of 6 litre 4 degrees C extra cellular type low potassium dextran solution (Perfadex). During the perfusion both thoraces were cooled topical by 0.9% saline ice slush. After back table separation the donor lungs was packed and transported with topical cooling.
The offer was refused in 27 cases due to donor history, in 31 cases due to allograft pathology. In 57 cases the harvesting was not performed due to logistic reasons. Forty three donor lungs have been transplanted, 6 harvested lungs underwent only histopathology. From 43 harvested lungs 41 bilateral and 3 single lung transplant procedures were performed. The mean cold ischaemic time (=CIT) was 3 75 +/- 50 minutes (range: 230-560 min). Forty two donor lungs showed excellent primary graft function. One allograft underwent down-sizing lobectomy, where the histology of the specimen showed multiple microembolization, and signs of fibrosis, bronchiolitis and anthracosis. In this case the cold ischaemic time was 385 min. The patient needed an extracorporeal membrane oxygenation (ECMO) support immediately postoperatively, and died on the 4th postoperative day. After induction of lung harvesting in Hungary the average waiting time of Hungarian citizens dropped within one year from 14 +/- 8 weeks (range: 2-36 weeks) to 2.6 +/- 1.3 weeks (range: 1-4 weeks). In 2002 3 Hungarian patients died while being on the waiting list, their waiting time was 1, 1, and 7 days. In 2003 the waiting list mortality for Hungarian patients was 0%.
After the introduction of lung harvesting both the waiting time and the waiting list mortality for Hungarian patients decreased. The potential yearly lung donor pool of Hungary is in the range of 5/1 million people.
自1995年起，匈牙利患者在与奥地利维也纳的双边合作下接受肺移植手术。2002年匈牙利开始引入肺获取技术。2002年之前，匈牙利患者从国外获得了16个供体肺，有4名患者在等待移植期间死亡。
2002年1月15日至2003年12月31日期间，匈牙利移植中心向科拉尼国家肺病研究所提供了164名潜在肺供体。供体选择按照国际指南进行。所有手术均作为多器官获取的一部分进行。在夹闭主动脉之前，立即静脉注射500微克依前列醇（弗洛兰）以开放肺血管床。通过主肺动脉用6升4℃细胞外型低钾右旋糖酐溶液（Perfadex）单次冲洗灌注肺。灌注期间，双侧胸腔用0.9%盐水冰泥进行局部降温。在后台分离后，将供体肺包装并在局部降温下运输。
27例因供体病史被拒绝，31例因移植物病理学被拒绝。57例因后勤原因未进行获取。43个供体肺已被移植，6个获取的肺仅进行了组织病理学检查。在43个获取的肺中，进行了41例双侧肺移植和3例单肺移植手术。平均冷缺血时间（=CIT）为375±50分钟（范围：230 - 560分钟）。42个供体肺显示出良好的原发性移植物功能。一个移植物进行了减容肺叶切除术，标本的组织学显示有多处微栓塞，以及纤维化、细支气管炎和煤尘沉着病的迹象。在这种情况下，冷缺血时间为385分钟。患者术后立即需要体外膜肺氧合（ECMO）支持，并在术后第4天死亡。匈牙利引入肺获取技术后，匈牙利公民的平均等待时间在一年内从14±8周（范围：2 - 36周）降至2.6±1.3周（范围：1 - 4周）。2002年有3名匈牙利患者在等待名单上死亡，他们的等待时间分别为1天、1天和7天。2003年匈牙利患者的等待名单死亡率为0%。
引入肺获取技术后，匈牙利患者的等待时间和等待名单死亡率均有所下降。匈牙利每年潜在的肺供体库在每100万人中有5个的范围内。
