Preissler Gerhard, Löhe Florian, Ebersberger Ullrich, Huff Ines, Bittmann Iris, Messmer Konrad, Jauch Karl W, Angele Martin K
Department of Surgery, Ludwig-Maximilians-University of Munich, Klinikum Grosshadern, Munich, Germany.
Transplantation. 2009 Jun 15;87(11):1602-8. doi: 10.1097/TP.0b013e3181a52ce1.
Organ donors are frequently trauma victims, but the impact of donor hemorrhagic shock and resuscitation (HSR) on pulmonary graft function has not been assessed. L-arginine treatment during reperfusion increases the production of endothelial nitric oxide and thus ameliorates ischemia-reperfusion injury. Objective of the present porcine study was to investigate the effect of donor hemorrhage on pulmonary graft function and potential beneficial effects of L-arginine administration.
In the control-group (n=6), lungs were harvested from donors without hypotensive periods. In the HSR-group (n=6) and HSR-Arg-group (n=6), donors were subjected to hemorrhagic shock (40% blood shed) and resuscitation before harvest. Left lungs were transplanted after hypothermic preservation of 18 hr, and graft function was observed for 6 hr after reperfusion. Recipients in the HSR-Arg-group received a bolus of L-arginine (50 mg/kg BW) intravenously 5 min before reperfusion followed by a continuous intravenous administration of L-arginine 200 mg/kg BW for 2 hr. Tissue specimens and bronchoalveolar lavage fluid were obtained at the end of the observation period.
Donor lung function did not differ between study groups. Compared with the control group, pulmonary graft gas exchange was significantly impaired in the HSR-group. Graft function in the HSR-Arg-group did not differ from control organs. Neutrophil fraction, protein content, and malondialdehyde levels in the bronchoalveolar lavage fluid in the HSR-group were higher compared with control and HSR-Arg-Group.
Although fulfilling ideal donor criteria, pulmonary graft function of lungs harvested from donors subjected to HSR is impaired, but improves significantly when l-arginine is administered during reperfusion.
器官捐献者常为创伤患者，但捐献者失血性休克及复苏（HSR）对肺移植功能的影响尚未得到评估。再灌注期间给予L-精氨酸治疗可增加内皮型一氧化氮的生成，从而减轻缺血-再灌注损伤。本猪实验的目的是研究捐献者出血对肺移植功能的影响以及给予L-精氨酸的潜在有益作用。
在对照组（n=6）中，从无低血压期的捐献者获取肺脏。在HSR组（n=6）和HSR-精氨酸组（n=6）中，捐献者在获取肺脏前经历失血性休克（失血40%）及复苏。左肺在低温保存18小时后进行移植，再灌注后观察移植肺功能6小时。HSR-精氨酸组的受体在再灌注前5分钟静脉注射一剂L-精氨酸（50mg/kg体重），随后以200mg/kg体重持续静脉输注L-精氨酸2小时。在观察期结束时获取组织标本和支气管肺泡灌洗液。
各研究组之间捐献者肺功能无差异。与对照组相比，HSR组的肺移植气体交换明显受损。HSR-精氨酸组的移植肺功能与对照器官无差异。与对照组和HSR-精氨酸组相比，HSR组支气管肺泡灌洗液中的中性粒细胞比例、蛋白质含量和丙二醛水平更高。
尽管符合理想的捐献者标准，但经历HSR的捐献者所获取的肺移植功能仍受损，但在再灌注期间给予L-精氨酸时可显著改善。
