Schueler S, De Valeria P A, Hatanaka M, Cameron D E, Bando K, Zeebley M, Hutchins G M, Reitz B A, Baumgartner W A
Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Md 21205.
J Thorac Cardiovasc Surg. 1992 Jul;104(1):73-82.
Donor core cooling with cardiopulmonary bypass is a valid method of clinical lung preservation. However, organ ischemia with this method is still limited to short-term intervals. Since circulating leukocytes participate in postischemic injury through the release of oxygen-derived free radicals, we examined whether leukocyte depletion by mechanical filtration could extend ischemic tolerance of the lung during preservation and subsequent double lung transplantation. Bovine donor lungs were preserved by donor core cooling (10 degrees to 15 degrees C) with cardiopulmonary bypass. Donor lungs were removed, stored in 4 degrees C donor blood for 24 hours, and transplanted. Graft function was studied for 6 hours after transplantation. Group 1 animals (n = 6) underwent standard cardiopulmonary bypass with whole blood for donor and recipient procedures. In group 2 (n = 6), leukocyte filters were incorporated into the cardiopulmonary bypass circuit in both donor and recipient operations. In group 2 recipient animals leukocyte counts decreased to 3% of mean baseline values and remained low during the experiment. Postischemic lung function (assessed by systemic arterial oxygenation, pulmonary artery pressure, pulmonary vascular resistance, airway pressure, lung water content, and end-point histologic characteristics) was significantly better preserved in the animals with leukocyte depletion. Leukocyte depletion by mechanical filtration in both donor and recipient improves the ischemic tolerance of the lung beyond that provided by donor core cooling alone, resulting in excellent lung function after 24 hours of ischemia.
体外循环下供体核心降温是一种有效的临床肺保存方法。然而，该方法导致的器官缺血仍局限于短期。由于循环白细胞通过释放氧衍生自由基参与缺血后损伤，我们研究了通过机械过滤去除白细胞是否能在肺保存及随后的双肺移植过程中延长肺的缺血耐受时间。牛供体肺通过体外循环进行供体核心降温（10摄氏度至15摄氏度）来保存。供体肺被取出，在4摄氏度的供体血液中保存24小时后进行移植。移植后对移植物功能进行6小时的研究。第1组动物（n = 6）在供体和受体操作中均采用全血进行标准体外循环。在第2组（n = 6）中，供体和受体手术的体外循环回路中均加入白细胞滤器。在第2组受体动物中，白细胞计数降至平均基线值的3%，并在实验过程中保持较低水平。缺血后肺功能（通过体动脉氧合、肺动脉压、肺血管阻力、气道压力、肺含水量和终点组织学特征评估）在白细胞减少的动物中得到了显著更好的保存。供体和受体均通过机械过滤去除白细胞，可提高肺的缺血耐受能力，使其超过单纯供体核心降温所提供的水平，从而在缺血24小时后实现良好的肺功能。
