Nishi Hideyuki, Date Hiroshi, Aoe Motoi, Shimizu Nobuyoshi
Department of Cancer and Thoracic Surgery (Surgery II), Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
J Heart Lung Transplant. 2007 Jun;26(6):610-6. doi: 10.1016/j.healun.2007.03.013.
We previously reported that lung inflation with oxygen, EPC-K1 (a diester alpha-tocopherol and ascorbic acid), urokinase and low-potassium dextran glucose (LPDG) solution can be beneficial in lung preservation. In the present study, a canine bilateral lung transplantation (BLT) model was used to evaluate long-term lung preservation of non-heart-beating donors (NHBDs).
Animals were euthanized without heparinization and left at room temperature for 2 hours until lung extraction. After cardiac arrest, the lungs were kept inflated with 100% oxygen. After extraction, the donor lungs were flushed with LPDG solution containing EPC-K1 (1.0 mg/liter), followed by injection of urokinase (120,000 IU) into the pulmonary artery. Eighteen BLTs were performed after preservation at 4 degrees C. Total ischemic time was scheduled for 12 hours in Group 1 (n = 6), 18 hours in Group 2 (n = 6) and 24 hours in Group 3 (n = 6). After BLT, recipients were followed up for 6 hours. An additional 6 BLTs were performed as a chronic study in the same setting as for Group 2.
All animals in Groups 1 and 2 showed excellent pulmonary function during the 6-hour post-transplant assessment time, in contrast to only 2 dogs from Group 3. In the chronic study, all 6 animals showed excellent pulmonary function for 24 hours (PaO2 = 528 +/- 8 mm Hg with 100% oxygen) and 2 of them survived for >1 week.
Successful chronic lung preservation (18 hours) using NHBDs is achievable in a canine BLT model.
我们之前报道过，用氧气、EPC-K1（一种二酯α-生育酚和抗坏血酸）、尿激酶和低钾右旋糖酐葡萄糖（LPDG）溶液进行肺膨胀对肺保存可能有益。在本研究中，使用犬双侧肺移植（BLT）模型来评估非心跳供体（NHBD）的长期肺保存情况。
动物在未肝素化的情况下安乐死，并在室温下放置2小时直至肺取出。心脏骤停后，肺用100%氧气保持膨胀。取出后，供体肺用含有EPC-K1（1.0毫克/升）的LPDG溶液冲洗，随后将尿激酶（120,000国际单位）注入肺动脉。在4℃保存后进行了18例BLT。第1组（n = 6）的总缺血时间设定为12小时，第2组（n = 6）为18小时，第3组（n = 6）为24小时。BLT后，对受体进行6小时的随访。在与第2组相同的条件下进行了另外6例BLT作为慢性研究。
在移植后6小时的评估期间，第1组和第2组的所有动物肺功能均良好，相比之下，第3组只有2只犬肺功能良好。在慢性研究中，所有6只动物在24小时内肺功能均良好（吸入100%氧气时PaO2 = 528±8毫米汞柱），其中2只存活超过1周。
在犬BLT模型中，使用NHBD成功进行慢性肺保存（18小时）是可行的。
