Inokawa Hidetoshi, Sevala Mayura, Funkhouser William K, Egan Thomas M
Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Ann Thorac Surg. 2006 Oct;82(4):1219-25. doi: 10.1016/j.athoracsur.2006.05.004.
We developed an ex-vivo circuit to evaluate human lungs retrieved from non-heart-beating donors. We assessed the effect of a similar circuit on the function of transplanted rat lungs retrieved from non-heart-beating donors.
One hour after death, Sprague-Dawley rat heart-lung blocks were flushed with 20 mL of cold Perfadex, stored cold for 1 hour, then warmed to 37 degrees C in a circuit perfused with Earle's crystalloid solution with or without washed porcine erythrocytes (hematocrit 12% to 15%). At 37 degrees C, lungs were ventilated for 15 minutes with alveolar gas, perfusion-cooled to 20 degrees C, flushed again with cold Perfadex, and then stored cold for 2.5 hours. The left lung was transplanted using a modified cuff technique with flow probes on the main and left pulmonary arteries. After 1 hour of reperfusion, arterial blood gases from the left pulmonary vein and wet/dry weight ratio (W/D) of both donor lungs were determined. Lungs transplanted after retrieval from heart-beating or non-heart-beating donors served as controls (n = 6 per group).
Lungs gained weight in the circuit but W/D and PO2 were similar after transplantation for all groups. After transplantation, vascular resistance was higher and dynamic compliance was lower for lungs perfused in the circuit. Myeloperoxidase and conjugated diene levels were modestly elevated in lungs transplanted from non-heart-beating donors irrespective of perfusion in the circuit.
Rat lungs are suitable for transplant after ex-vivo perfusion and ventilation. This model closely mimics methods used to evaluate the function of lungs retrieved from human non-heart-beating donors and can economically evaluate ex-vivo therapies for lungs retrieved from non-heart-beating donors.
我们开发了一种体外回路来评估从非心脏跳动供体获取的人类肺脏。我们评估了类似回路对从非心脏跳动供体获取的移植大鼠肺功能的影响。
死亡1小时后，用20毫升冷的Perfadex冲洗斯普拉格-道利大鼠心肺块，冷藏1小时，然后在灌注有Earle氏晶体溶液（含或不含洗涤过的猪红细胞，血细胞比容为12%至15%）的回路中加热至37摄氏度。在37摄氏度下，用肺泡气体对肺进行15分钟通气，灌注冷却至20摄氏度，再次用冷的Perfadex冲洗，然后冷藏2.5小时。使用改良袖套技术移植左肺，并在主肺动脉和左肺动脉上安装流量探头。再灌注1小时后，测定左肺静脉的动脉血气和两个供体肺的湿/干重比（W/D）。从心脏跳动或非心脏跳动供体获取后移植的肺作为对照（每组n = 6）。
在回路中肺脏重量增加，但所有组移植后W/D和PO2相似。移植后，回路中灌注的肺血管阻力较高，动态顺应性较低。无论回路中是否灌注，从非心脏跳动供体移植的肺中髓过氧化物酶和共轭二烯水平均适度升高。
大鼠肺在体外灌注和通气后适合移植。该模型紧密模拟了用于评估从人类非心脏跳动供体获取的肺功能的方法，并且可以经济地评估针对从非心脏跳动供体获取的肺的体外治疗方法。
